Medical Records Request Form

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Facility Information
Medical Information
Authorizations & Delivery
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Request_Medical_Records_English

Your Information

Date of Birth:

Phone (H):

Phone (W)or(C):

Address

City

State/Province

Zip/Postal

Are you getting records from another provider or facility for LCHC?

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If you are human, leave this field blank.

Questions?

Call our Medical Records Department at 781-586-6659.

This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. LCHC complies with USDA guidelines as an equal opportunity employer.

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