Records Request Form

Patient Request

You will need to complete a records release form. This form is available in person, electronically or by mail. Contact our Billing Office at (336) 703-2770 to receive this form.

You may also pick up your records in person at: 911 E. 5th Street, Winston-Salem, NC 27101 (You will need to bring a current government issued photo ID)

Attorney Request

Attorneys can mail or fax a request along with a patient authorization. They should be mailed or faxed to:
P.O. Box 863, Lewisville, NC 27023
Phone: 1-800-814-5339
Fax: 336-740-9729

Due to Health Insurance Portability and Accountability Act of 1996, Medical records can only be released to the patient, parents/guardians of minors, or others legally authorized to do so on behalf of the patient.