Download the Medical Records Authorization to Release Information form.
- Please return the completed form via fax, standard mail, or a courier service, such as FedEx or UPS. These forms are not accepted via email.
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
- There is a minimum fee of $10.00 to process each request (NC GS 90-411). The cost for processing the request is as follows:
- 75 cents per page for the first 25 pages
- 50 cents per page for pages 26 through 100
- 25 cents per page for pages over 100
If the number of pages is fewer than 25, the minimum fee will be charged.
- As soon as the cost for processing the request has been determined, the Medical Records Department will contact the requestor with payment options.
- Records will be sent as soon as payment is received. Please allow up to 30 days to for requests to be processed.
Other resources on this site: