Medical Record Release

At your request, we will provide you with a copy of your child(ren)’s medical records. We must have a release form signed by you. Below are instructions for obtaining your child’s records.

Instructions

  1. Your medical records can only be released when:
    • the Medical Record Release Form is completed;
    • signed by the parent, patient or legal guardian;
    • signed by a witness; and
    • returned to us by mail.
  2. Click here to download a printable (PDF) copy of the Medical Record Release Form, or call our office at (617) 735-8585, option 5. We can send the form to you or fax it to you. We need your original signature when you return the form so please mail it back to us at the following address:Centre Pediatrics Associates, PC
    Attn: Medical Records
    One Brookline Place
    Suite 327
    Brookline, MA 02445
  3. There is a processing fee of $15 associated with this request, an amount established by state law. Please enclose a check payable to Centre Pediatric Associates, P.C. or provide your credit card information with your request.
  4. Every effort will be made to process your medical release request within 14 working days.