Medical Record Request


All requests for release of medical information must be made by fax or U.S. mail. For your protection, email requests cannot be honored at this time.

To obtain your medical records:

  1. Download and print this form: PDF icon SBCHC Release of 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.
  4. Send us your completed form by:



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



Medical Records Department

Please note that unfinished forms will be returned by mail for completion.