To obtain your medical records, please follow the instructions below: Complete this form: Patient Request for Health Information Write us a letter requesting the release of your health information. The letter should include: Patient first name, last name, and date of birth The specific health information you’d like released (e.g., specific date of service, specific condition, specific physician, date range) The medical record format you prefer (paper or electronic) The person designated to receive the records Where to send the records The signature of the person whose medical records will be released (or their legal representative) Send the letter and the completed form to: info@yorktownhealth.com
