Request Medical Records

A patient may request a copy of their medical records from Holyoke Medical Center by completing the Authorization To Use and Disclose Health Information Form

Click here to download the form in English:
Authorization To Use and Disclose Health Information Form ENGLISH (PDF)

Click here to download the form in Spanish:
Authorization To Use and Disclose Health Information Form SPANISH (PDF)

Please mail your completed form to:
Holyoke Medical Center
Health Information Management
575 Beech Street
Holyoke, MA 01040

Or fax to: 413-534-2618