RECORDS RELEASE FORM

The USB release of records form deadline was June 30. We will no longer process release of records from our office as it closed as of July 3, 2024.

We announced our retirement June 1, 2023 and we have had in person notifications as well as email and text bulk campaigns notifying our patients of the retirement and how to get your records.

A Medical Records service will handle all release of records from now on and charges will incur per Ohio State Law allowed charges. Send all release of records requests to:

•               Medical Records
•               Canton Women's Center
•               PO BOX 2217
•               Westerville, OH  43086
• Fees for Patients and Personal Representatives
  For data recorded on paper or electronically: $3.62 per page for the first 10 pages; $0.76 per page for pages 11-50; and $0.30 per page for pages 51 and higher.
  Postage: Actual costs incurred by the healthcare provider or medical records company with respect to postage costs.
• Release of Records form click here.