To request the release of your private health records, please download and fill out one of the authorization form below. Then call the site where you received treatment to ask how you should submit the form. Completed authorization forms can also be mailed to the address listed on the form.
Please note that you should not use this form if you want to view your medical records electronically on MyChart. For more information on how to sign up for MyChart electronic medical records, please visit our MyChart page.