Request Medical Records

For Bridgeport, Greenwich
and Yale New Haven hospitals
or Northeast Medical Group

 Download this fillable PDF form and complete it.

Print the document, sign it, then fax, email or mail it to:

Yale New Haven Health
Health Information Management 
Release of Information Services
PO Box 9565
New Haven, CT 06535
Fax: 203-688-4645
Email: [email protected]

For Yale Medicine Providers:
Fax: 203-200-1287
Email: [email protected]

For X-rays or other radiological images, call 203-688-6054. Fax completed forms to 203-688-8812.

For Lawrence and Memorial Hospital

 Download this fillable PDF form and complete it.

Print the document, sign it, then fax, email or mail it to:

Lawrence + Memorial Hospital
Health Information Management
365 Montauk Ave, New London, CT 06320
Fax: 860-444-3760;
Email: [email protected]

For X-rays or other radiological images, call 860-442-0711, ext. 2578.

For Westerly Hospital

 Download this fillable PDF form and complete it.

Print the document, sign it, then fax or mail it to:

Westerly Hospital
Attention: Medical Records
25 Wells Street
Westerly, RI 02891
Fax: 401-348-3774

For X-rays or other radiological images, call  401-348-3292 or fax 401-348-3488.