Request Medical Records

In accordance with the Health Insurance Portability and Accountability Act of 1996 and Connecticut law, you have a right to your health information.

Now you have access to your medical record through the ONS Patient Portal immediately at no cost.
Login to your Patient Portal account and click the Health Records icon.

Health record

Alternatively, you may complete and sign the online medical records request form below.  You may be charged up to $0.65 per page, to cover research fees, handling fees and the cost of first class postage if applicable. Requests will be processed in one to three business days.

Once the form has been completed, a medical records coordinator will contact you if more information is needed.

PLEASE NOTE: We cannot release records without a completed and signed authorization.  If you are picking up records in person, you must present a photo identification.

For other questions related to medical records, please call 203.869.1145, option 5.

 

Request Medical Records Form

  • Records you would like to access:

    Please note: MRI reports are available through the Patient Portal. We are unable to send images via the portal. Electronic copies of images can be sent to another Physician’s office, or may be picked up upon presentation of a State issued photo ID at the ONS Medical Records office at 6 Greenwich Office Park, Greenwich.
  • Please specify approximate range of dates of appointment(s):
  • Or fax records to:
  • Charges

    I understand that when my medical records are sent to me by the ONS Patient Portal, there is no charge for this service. I also understand that you may charge me up to $0.65 per page for printed copies, including any research fees when I pick up copies in the office. Handling fees and the cost of first class postage may also be applied if records copies are mailed by US postage. I also understand that you may charge me $10.00 for a CD copy of my X-ray or surgical images, and $15 for a CD copy of my MRI. I hereby agree to pay the copying charges specified above.
  • Verification

  • YYYY-MM-DD