Patient Record Requests

Patient record request

For patients requesting that their records be released to a 3rd party:

Complete the Release of Information and the Consent To Communicate forms above, attach both forms to the message box on the left, include your name, DOB, phone#, mailing address, and e-mail address. We will contact you to make arrangements to verify your identity via video communication.

Please note that we do not fax records.

For patients requesting their personal records:

Complete the Consent To Communicate form above, attach form to the message box on the left, include your name, DOB, phone#, and mailing & e-mail addresses. We will contact you to make arrangements to verify your identity via video communication.

Coastal Neuropsychological Services
Dr. Christy L. Jones

FORMS