Ascension St. Ben's Clinic

Medical Records Information

1. Call the Ascension Columbia St. Mary's Hospital or doctor's office that holds your records** or
2. Print and complete a release form (listed below) and submit it to your doctor's office or the hospital that holds your records. We cannot provide medical records based on an email or emailed online form. The form must be either faxed or mailed.

Release Forms

*Medical Records Department phone numbers can be found by clicking on either form below.

**Please Note: You will be charged a small fee for a full copy of your medical records or for more than one copy of any portion (or portions) of your medical records. There is NO charge for a single copy of any ONE portion of your records.

• General Medical Information Release Form
• Spanish General Medical Information Release Form
• Behavioral Medicine Medical Information Release Form