Requesting Your Medical Records

Requesting Your Medical Records

We are happy to provide you with a copy of your medical record. To request a copy of your medical record, you, or someone you designate, must complete the Authorization to Release Patient Health Information form. We do not accept requests by phone.

In order to protect your privacy, only the patient, parent/legal guardian or the patient's legal representative can sign the form to disclose medical records. The authorization form must be legible and complete to process your request.


Click Here to Request Medical Records


You may also follow this link to complete and sign the form electronically in DocuSign:


Fees for Medical Records

Fees for printing copies of medical records are determined by the number of pages:

  • $18.53 for the first ten pages
  • $0.85 for pages 11‐40
  • $0.57 for pages 41+

Copies of records are sent to medical facilities or other physicians at no charge