Medical Records

MEDICAL RECORDS REQUESTS

Your request for copies of medical records for your own use or for disclosure to health care providers, insurance companies, attorneys, or other third parties must be made in writing to Warren Street Family Counseling.

To request medical records:

By Phone:
– (603) 226-1999 ext. 111 to leave a message with the following information:
– Name of client
– Name of Parent / Guardian if client under the age of 18
– Mailing Address
– A Medical Records Release form will be mailed to you.

By E-mail:
– email jmccarthy@wsfca.net the following information:
– Name of client
– Name of Parent / Guardian if client under the age of 18
– Mailing Address
– A Medical Records Release form will be e-mailed to you.

By Fax:
– A Medical Records Request form may be faxed to: (603)224-1675.
– Please fax to the attention of: Medical Records

Below you will find a link to our Medical Records Release form. Once the form is completed and signed, it can be mailed or hand delivered to the office:

Warren Street Family Counseling Associates
33 Warren Street
Concord, NH 03301.

There may be a fee for the copies we provide. N.H. state law regulates our fees. We will inform you of the fees prior to completing your request.

Medical Records Release

All forms, unless noted, require Adobe Reader.

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