Requesting your records.

How to request your records

To protect your privacy, records requests must be made in writing with your signed authorization.

1. Complete the authorization form. Download and fill out our Authorization for Release of Medical Records form below. If you're requesting records for someone else, you'll need the proper legal authority (for example, as a parent, guardian, or personal representative).
2. Tell us what to release and to whom. Include the records you need, the date range, and where they should be sent — to you, or to another provider.
3. Return the signed form. Bring it to any of our offices, or fax it to our medical records team using the number below.
4. We process your request. Under federal law, we'll complete your request within 30 days, or let you know in writing if more time is needed.

Where to send your form

Good to know

• There is no charge for records sent directly to another treating provider for your care.
• A reasonable, cost-based fee may apply for copies requested for personal or legal use, as allowed by law.
• You may revoke your authorization in writing at any time, except where information has already been released.
• For urgent transfers before an upcoming appointment, please call us so we can help expedite your request.

Great Lakes Eye Care protects your health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA). To learn how we use and safeguard your information, see our Privacy Policy.