Locations

Ascension Brighton Center for Recovery

  • Specialty Care

Release of Information Form


If you need a copy of your medical records, print and complete the Release of Medical Records Authorization form.  This form can be used to release Patient-identifiable Health Information to anyone that a patient authorizes in writing to receive such information.

Instructions on how to fill out the form are also included second page of the form.  Please follow the instructions carefully so that the release is filled out correctly and therefore a valid release.

Fax the completed authorization form to our Health Information Department at 810-220-5519 or mail the completed authorization form to:

Attn: Health Information Dept.
Ascension Brighton Center for Recovery
12851 Grand Rive Rd.
Brighton, MI 48116


You can also begin the process for getting treatment for a patient at Ascension Brighton Center for Recovery by completing our Secure Online Admission Form.