Request for Medical Records

All requests for release of medical information must be made by FAX or US MAIL. For your protection, email requests cannot be honored at this time.

To obtain your medical records:

1. Download and print the Authorization for Release of Health Information Form.

2. Please fill in all required information for processing of the Form.

3. Please review the authorization where an individual check off is required. Make sure you have signed and dated the form for release of this information.

Please click here to download the Medical Record Release Request Form

Please note that requests that are not completed, signed and dated will be returned by mail for completion.

When the form is completed, you may:

Fax the form to the Medical Records Department at (617) 464-7535

-or-

Mail the form to:

South Boston Community Health Center
409 West Broadway
South Boston, MA 02127
ATTENTION: Medical Records