In order to send a Medical Records Request to our Health Information Management (HIM) Department, please complete the submission form below. One of our team members will follow up with you directly. If you have an urgent request, or need to speak with someone, please call us at 540.316.4444.
Patient Authorization for Disclosure Form
In order to complete a Medical Records Request, the patient or authorized representative may be required to complete a patient authorization for disclosure form.
ENGLISH Request Form SPANISH Request Form