Contact & Us
Medical Records Release
If you would like to request a copy of your medical records, please download the appropriate Toledo Clinic Authorization Form. This form must be completed and signed for The Toledo Clinic to release your medical records to you or another party. Once completed, please return the forms to:
Toledo Clinic Medical Records
4235 Secor Road
Toledo OH 43623
or Fax to 419-479-3975
Please allow time for processing and be aware that there may be a financial charge for medical record copies.
 |
Authorization for Use or Disclosure of Medical Record Information Explanation |
|
Authorization for Use or Disclosure of Medical Record Information Form |
|
Authorization For Use or Disclosure of HIV Testing Information Form |
|
Authorization For Use or Disclosure of Mental Health or Psychotherapy Notes/Information Record Information Form |
|
Authorization For Use or Disclosure of Substance Abuse Notes/ Record Information Form |
