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Medical Records Request


Click here to download the Medical Records Request form (authorization to release health information). 

PLEASE NOTE: the release form must be signed

Patients are able to receive one copy of their medical records free of charge.

Any additional requests are charged the following fees:

Base processing fee:     $23.71 +
                                              $1.19 per page pages 1 – 20
                                              $0.60 per page pages 21 – 50
                                              $0.23 per page pages 51 +

Requests will be completed within 30 days of the date they are received. Records can be mailed or picked up in person by the patient.

Hours

Monday: 8:00 am – 8:00 pm
Tuesday: 8:00 am – 5:00 pm
Wednesday: 8:00 am – 8:00 pm
Thursday: 8:00 am – 5:00 pm
Friday: 8:00 am – 4:00 pm

After hours care:
1-877-673-0237
(for established patients)

Business Office

1719 S. Garfield Avenue
Traverse City, MI 49686
Main Line:
231-935-0799 / 1-866-483-6987
Media Inquiries:
231-642-5895