Request Medical Records

Hours of Operation

Holiday hours may vary

Option 1: By Mail or Fax

Please print and complete the form below:

• Authorization to Release Protected Health Information (English)
• Authorization to Release Protected Health Information (Spanish)

This form is in .PDF format and will require the Acrobat Reader plug-in to view.

Then mail, deliver in person, or fax the completed form:

Fax:  770-219-6903

Please Note:

• We will be unable to process incomplete forms
• When mailing the form, please include a copy of your photo identification/driver’s license.
• Please also ensure that you include your telephone number in the event we have any questions regarding your request.

Option 2: Download via MyChart

About MyChart Proxy Access

• Access Authorization to an Adult MyChart Record (English)
• Access Authorization to an Adult MyChart Record (Spanish)
• Access Authorization to a Minor's MyChart Record (English)
• Access Authorization to a Minor's MyChart Record (Spanish)

Other Records

• Request Changes to your Medical Record
• Children’s Records:  Before your child’s medical records can be released, the legal guardian must complete, date and sign a release of information authorization.  If the child is over the age of 18, he/she must request the information himself.
• Mode of Release:  Medical records can be faxed only to a physician’s office, hospital, or clinic.  There is no charge for this service.  If you are requesting records be sent to yourself or any place other than those listed above, there are fees associated with production of records. 
• You may make an appointment to pick up copies of the record from our office during normal business hours.  Records can only be picked up with proper photo identification.  Otherwise, records will be mailed.
• Associated Fees:  Please see the Fee Schedule Acknowledgement form attached to the authorization form (above) to see the most current fee requirements based on Georgia regulations..