You can request a copy of your medical records from the Office of Medical Records. Please follow the instructions below and complete the Authorization to Release Medical Records Form to help us process your request. Please note, a written request needs to be provided prior to processing. We are providing this downloadable form for your convenience.
Medical Records | Contact Information Email: mr@bronxcounselingcenter.comAll sections of the form must be completed in order for medical records to be released.
Print clearly, designate whether you require the entire record or a specific portion, and include the mailing address to which the records are to be sent (either your address or the address of your physician).
Submit Form Upload and email your completed signed form here or fax to: 646-461-2305. Please include the best way to contact you should we have any questions about your request.
FOR HEALTHCARE PROVIDERSPhysician office or hospital can request records during office hours by faxing a request on letterhead to 646-461-2305 or email from a company email address. Please include the patient’s name, DOB, and designate entire record or specific portion(s).
COVID-19 TEST RESULTS, PLEASE CALL 646-362-9799 FOR 3rd PARTY REQUESTSAny third-party requestors should submit a request for patient records by following the process above with the legally required documentation