Click here to print a Release of Information form to request your medical record.

To request your medical record:

Requests can be done in person or by mailing in a written request that includes your name, date of birth, social security number, and the approximate date(s) of service.

Please state the purpose of the request and specify what part of the medical record you need. Please indicate who we should send the record to and include the address, or indicate if you will be picking it up. Please do not forget to sign and date your request.


Send medical record requests to:

Faulkner Hospital
Correspondence
1153 Centre Street
Boston, MA 02130
Phone: 617-983-7960

Send all imaging requests to:

Faulkner Hospital
Image Service Center
1153 Centre Street
Boston, MA 02130
Phone: 617-983-7169
Fax: 617-983-4424