Medical Records Request
Click here to download the Medical Records Request form (authorization to release health information).
PLEASE NOTE: The release form must be signed.
Patients are able to receive one copy of their medical records free of charge.
Any additional requests are charged as follows:
Base Processing Fee: $23.71 +
- $1.19 per page (pages 1 - 20)
- $0.60 per page (pages 21 - 50)
- $0.23 per page (pages 51+)
Requests will be completed within 30 days of the date they are received. Records can be mailed or picked up in person by the patient.
I may worry about making ends meet, but I no longer worry about my daughter’s health.Kim, patient and single mom