Medical records request

To request a copy of your medical record for yourself or another individual or organization, please complete one of the following forms.

pdfPatient request for medical record

pdfAuthorization to release your medical record to an individual or organization

Once you complete the form, please mail it to:

Mayfield Brain & Spine
3825 Edwards Rd.   Suite #300
Cincinnati, Ohio 45209
ATTN: Medical Records