Patient Resources

Requesting your Medical Records

Our office requires a Medical Release form in order for you to receive your records or for your records to be sent to another physician’s office. There will be a $30 fee for you the patient to receive a copy of your medical records. If you request your records be sent to another physician’s office there will be no charge.  In the case that we refer you to another physician we will send your records to that physician without a consent due to coordination and continuity of care.
There are two separate forms that are available. The Patient Access form available in English and Spanish is when you the patient request the records for yourself or to be sent to another medical provider. If you are requesting your medical records for a third party, for example an insurance company, FMLA papers, disability, lawyer, etc, then the Release of Information authorization form is the form that needs to be filled out in its entirety. Active MyChart patient accounts give you the ability to request your medical records. Log into your MyChart and request your records to be uploaded to your MyChart, be mailed to you and or mailed/faxed to another medical provider.
These forms are a legal document therefore our staff cannot fill out any information on the form nor can we correct it if the information is incorrect. If you have questions, please contact our office for assistance, 336-275-5391.

Click the link below and print the correct Release form for your needs. Please fill it out and fax to our office 336-275-4702, place in the mail to Greensboro Gynecology 719 Green Valley Rd Ste 305 Greensboro NC 27408 or email to greensborogynecology@conehealth.com.  Please allow up to 2 weeks for your request to be completed. Thank you.

PtAccessRequestEnglish

PtAccessRequestSpanish

CHMG Release of Information form.6.14.14

CHMG Release of Information form – Spanish.6.14.14

Patient Resources

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