How to Request Records
Follow the steps below to request a copy of your clinical records.
1. Complete the Request Form
Please complete the Medical Records Request form to submit your request.
3. Verify Your Identity
A copy of a valid, government-issued photo ID is required for all requests.
5. How You’ll Receive Records
Records are delivered by secure, encrypted email only.
A reasonable, cost-based fee may apply. You will be notified of any applicable fees before your request is processed.
2. Provide Required Information
Include the client’s full name, date of birth, dates of service, and any additional information requested in the form.
4. Requests for Minors
Parents or legal guardians requesting records for a minor must provide proof of their legal relationship (such as a birth certificate, court order, or guardianship documentation) along with a valid photo ID.
6. Processing Time
Requests are processed within 30 days of receiving a complete form and verifying your identity.
Questions?
If you have questions about requesting your clinical records, please contact Jay Adkins at jay@empoweredtoconnect.org.
