Request Medical Records

    Your Information


    Records Requested

    Please describe the records you need, such as a complete medical record, discharge summary, or medication history. You may also include the purpose or special instructions, but this is optional.

    Submitting this form starts your request. Our Medical Records team will verify identity and any required authorization before releasing records.

      Your Information


      Client Information


      Records Requested

      Please describe the records you need, such as a complete medical record, discharge summary, or medication history. You may also include the purpose or special instructions, but this is optional.

      Submitting this form starts your request. Our Medical Records team will verify identity and any required authorization before releasing records.

      If you experience any issues submitting this form or need assistance completing your medical records request, please call 904-990-1200 and press 5 for Medical Records. Our team will be happy to assist you.