Sending Your Medical Records to Us

If you need to send your medical records from another healthcare provider to our facility, please provide them with the following information and form:

1. Download and complete the Authorization to Release Medical Information Form.
2. Fill out the form with your information and specify that the records should be sent to MyCatholicDoctor.
3. Provide the other healthcare provider with our contact information:
   • Recipient: MyCatholicDoctor, Medical Records Department
   • Address: 1180 Newfield Ave., Stamford, CT 06905
   • Fax: (203) 590-8644
   • Email (if applicable for receiving records): [Your Medical Records Department Email Address (Optional)]
4. Inform the sending provider of any specific records or dates they should include.

[Link to Your Authorization to Release PDF] – Download Authorization to Release Form (PDF)

Contact Information

If you have any questions or require further assistance, please do not hesitate to contact our Medical Records department at:

Phone: (888) 822-8436 Email: [Your Medical Records Department Email Address]

To request a copy of your medical records, please follow these steps:

1. Download and complete the Medical Records Request Form.
2. Carefully fill out all required fields on the form.
3. Submit the completed form to our Medical Records department via one of the following methods:
   • Mail: 1180 Newfield Ave., Stamford, CT 06905
   • Email: [Your Medical Records Department Email Address]
   • Fax: (203) 590-8644
4. Please allow 5 business days for your request to be processed. You may be contacted for verification or clarification.
5. Information regarding fees, if applicable, can be found on the request form.