Medical Release Form

To request medical records please download and print the medical release form.

Return the form by doing one of the following:

Releasing of medical records costs:

  • First 10 pages are free/ calendar year
  • Records over 10 pages costs $15.00 + .25/ page over 10 pages
  • Records can be picked up in person (with identification) or mailed *certified mail.
  • *Records mailed will be charged certified mail postage in addition to any processingfees.