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MEDICAL RECORD RELEASE FORM

To:

  • release copies of your medical record,
  • review your medical record,
  • or obtain copies of your medical record from another facility

please print, complete, and mail the medical record release form to:

Bulfinch Medical Group
Wang Ambulatory Care Center
15 Parkman Street- 5th Floor
Boston, MA 02114

OR

Fax the completed form to (617) 724-6649

PLEASE NOTE: There is a 3 week turnaround time to process your request.

If you have any questions regarding the release please contact Angela Perri at (617) 724-6678.

 

© 2006 Massachusetts General Hospital : Bulfinch Medical Group : 15 Parkman Street, Wang Ambulatory Care Center, 5th Floor : Boston, MA 02114 : Privacy : Disclaimer