Medical Records Release Form

To request a copy of your medical records or the transfer of your records, please complete and submit the medical records release authorization form below. These records will be maintained in accordance with applicable law and will be available to you upon request.

Download the medical records release form below:

Download Medical Records Release Form

When you have completed the form above, please submit it via FAX to (804) 342-4185

To verify your form submission has been received or for more information about our medical records release authorization process, please call (804) 342-4187