Written Requests

For your protection, a copy of a health record will not be released to third parties without your written authorization. Health information cannot be released over the telephone. The Health Records department at one hospital cannot release the health records from another hospital. For example, Alexandra Marine and General Hospital (AMGH) cannot accept a request to release/copy health records from Stratford General Hospital (SGH).

Please complete the Consent for Access or Disclosure of Personal Information and/or Personal Health Information Form. This form can be printed from our web site or picked up at our Health Records department. To avoid delay, please make sure that all information is completed on the form, ensuring that it is dated and signed by you.

This form can be mailed, or dropped off in person at the Health Records Department, ideally at the site where you were treated. To expedite your request, the form may be faxed to the fax numbers on the Contact Information page, however the original must be mailed or dropped off to the site where you were treated. For your protection, copies may not be released without the original, signed form.

This authorization is valid for 6 months and pertains to the release of information that is specific to treatment received on or before the date signed.