Medical Records

To request a copy of your medical records from our Medical Records Department, download and complete the Medical Records Release Form. Once completed, attach it to the online form below, or mail to: Medical Records Department 835 S. Van Buren St., Green Bay, WI 54301 Call (920) 433-8172 
for more information.
 

Step 1

Download and complete the Medical Records Release Form.

Download



Step 2

Submit your completed Medical Records Release Form via mail at Medical Records Department 835 S. Van Buren St., Green Bay, WI 54301, or attach in the form below. 

Today
()-
Security code

Notice of Nondiscrimination:  English

Language Assistance:  Español | Hmoob | Deutsch | Français | 繁體中文 | Deitsch | Polski | العربية | Русский | Italiano | Tagalog | हिंदी  | ພາສາລາວ | 한국어 | Tiếng Việt | اُردُو |