Release of Patient Records


It always saddens us when patients leave the practice. If you should need to leave, we hope you will be willing to tell us why, so that we can use that information to help make us better in the future.

When patients leave, we will be happy to provide a summarized copy of their records at the family’s request. Please give us 60 days advance notice for this service.

Medical records are provided by email at no charge or on paper for a small fee.
  • As a courtesy, medical records are provided to our patients by e-mail at no charge.
  • Records may be expedited for a $25 fee in addition to the fees explained below.
  • If you would like to receive paper copies, there will be a fee based on the current year’s fee schedule determined by the Ohio Department of Health, but not to exceed $25. The current fee schedule is available at  
  • If the patient/s account holds a balance with our office, the medical records will also be subject to the current year’s fee schedule, but not to exceed $25 unless the account is paid in full.
  • If a second copy of the medical records is requested at any time, there is a fee of $25.  Fees for second copies on paper remain additional.
  • Fees for any of the above requests will be due before the medical records are released.
  • Requests for medical records by specialists to whom we have referred your care, will be provided in summary form free of charge.
  • Additional fees will apply for records requests by attorneys and insurance companies because of the nature of their requests.  Those fees are traditionally paid for by the requesting party.
  • We are not permitted by law to release any documents which have not been created by our practice.  If you desire copies of another provider’s medical records, you will need to request them from the provider of origin.

Click Here to view and print the form required to release medical records. Click Here  if you are a new patient and would like to have your previous doctor’s records sent to us. Please fill out the applicable form and mail, email to, or fax it to our office at 216-291-9422.