Records Release

Tell us where to find your records.

You've already signed your records release authorization during registration. This quick form just tells our team where to look, so we can gather the right records before your first visit.

Your records may be spread across more than one system. Check every place you've received care, and add anything else we should know in the comments. We'll handle the requests from there.

Helps each health system match your records to the right person.

Which health systems have you received care from? *

Select all that apply.

Specific providers, clinic locations, approximate dates of care, or a smaller or out-of-state office not listed above.

Got it. You've indicated you do not want us to access your previous records. We will note this and will not request anything. You can still submit the form so our team has it on file.

Your information is sent securely to Simplicity Health and used only to request your records.

Thank you.