Medical Records Request

Medical Records Release Forms

Please use the Medical Records Release form for the center you wish to obtain records from.
Please complete the form for the center in which you were seen and either fax or mail the complete form to the appropriate office.
Please click the sample form below to see a properly completed medical records release form.
In the event you have any questions pertaining to your records, please call the respective center where you had services performed and a patient advocate will be happy to assist you.

Atlanta Women’s Center Medical Records Release

Atlanta Women’s Center
235 West Wieuca Rd
NE Atlanta, GA 30342
Phone: (404) 257-0057
Fax: (404) 257-1245

Cherry Hill Women’s Center Medical Records Release

Cherry Hill Women’s Center
502 Kings Highway N
Cherry Hill, NJ 08034
Phone: (856) 667-5910
Fax: (856) 667-8304

Hartford GYN Center Medical Records Release

Hartford GYN Center
1 Main Street, Suite N1
Hartford, CT 06106
Phone: (860) 525-1900
Fax: (860) 522-9913

Philadelphia Women’s Center Medical Records Release

Philadelphia Women’s Center
777 Appletree Street
7th Floor
Philadelphia, PA 19106
Phone: (215) 574-3590
Fax: (215) 574-3595

Delaware County Women’s Center Medical Records Release

Delaware County Women’s Center
CCMC Annex-Alexander Silberman Center
1 Medical Center Blvd.
Chester. PA 19103
Phone: (610) 874-4361
Fax: (610) 874-4363