How to Request Your Medical Records:

To request a copy of a medical record, please use the following steps:

  1. Complete and sign the Medical Records Authorization to Release Information form. Failure to complete the form in its entirety form may cause unnecessary delays in obtaining the copy of the record. The completed form must have the signature of the patient to be processed. 
Forms & Documents for Pavillon Treatment Center
  1. The completed form must be returned via fax, standard mail, or a courier service such as FedEx or UPS.

If sending via standard mail or a courier service, please use the following address: 


Medical Records Department 

241 Pavillon Place 

Mill Spring, NC 28756 

If faxing, please use our Medical Records Department’s fax number: 1-888-480-4691 

  1. You may also call the Medical Records Dept and request to be sent the form via Docusign so it can be signed electronically.

Phone 828-694-2300 Ext. 143

  1. There is no charge for records as long as they are sent electronically. This includes fax or email.

If records are emailed to you, it will be sent via a link from a program called ShareFile. You will need to put in your name and email to download.

Please feel free to contact the Medical Records Department with any questions or concerns you may have regarding the form or the process.

Other resources on this site: