Locations

Eastwood Clinics - Clinton Township

  • Primary Care/Clinic
Hours Call us for daily hours
Appointments

Medical Records Request

As a patient, you have the right to access your medical records. Here you'll find instructions and a convenient form to help us process your request.

Under Federal and State law, a patient has a right to request a copy of his or her medical records. However, a completed written authorization is required prior to processing a request. For your convenience, St. John Providence, part of Ascension, has made available a medical records authorization form that may be downloaded for your personal use. Be sure to specify the dates of service and the type of information needed. If you are requesting records be sent to you, you will receive a bill.

Mail the completed authorization form to:

St. John Hospital & Medical Center
Health Information Management Dept.
22101 Moross Rd.
Detroit, MI 48236

Questions? Call 313-343-3780.

Medical Records Authorization Form