How to Request Records from Our Practice

We are committed to maintaining the privacy and security of your personal health information. If you need to request records from our practice, please follow the guidelines outlined below to ensure a smooth and efficient process.

For Clients and Parents/Guardians of Clients

If you are a client or a parent/guardian of a client, you can request records by following these steps:

  • Complete a Records Request Form: Download and fill out our Records Request Form, available on our website or at our office. This form helps us understand exactly what records you need and for what purpose.

Document Request Form

  • Submit the Form: You can submit the completed form via email or in person at our office. If you choose to email the form, please send it to [email protected].
  • Processing Time: A treatment summary will be provided upon request. For more detailed records, another request must be submitted, including the specific dates of service required.
  • Fees: In some cases, there may be a fee associated with copying and sending records. We will inform you of any charges before proceeding.

For All Other Requests

For non-client requests (such as requests from legal representatives, insurance companies, or third parties), please follow these guidelines:

  1. Submit a Formal Request via Fax: Send a formal request on official letterhead via fax to 757-601-8254. Your request should include:
    • The name and contact information of the requesting party
    • A detailed description of the records needed
    • The purpose of the request
    • Any relevant client information (e.g., client’s name, date of birth)
    • Signature of the authorized person requesting the records
  2. Verification of Authorization: We require appropriate authorization for all record requests. For legal or third-party requests, please include a signed consent form from the client or the client’s parent/guardian.
  3. Processing Time: As with client requests, a treatment summary will be provided upon request. For more detailed records, another request must be submitted, including the specific dates of service required. Formal requests require 10-15 business days of processing time from the date of the request, longer processing time may apply dependent on the number of requests in processing.
  4. Fees: Fees may apply for processing and copying records. We will notify you of any charges before completing the request.

Contact Information

For any questions or further assistance, please contact us at:

  • Phone: 757-758-3042
  • Email: [email protected]
  • Fax: 757-601-8254
  • Office Address: 1403 Greenbrier Pkwy, Suite 225, Chesapeake, VA 23320

Thank you for your cooperation. We are here to assist you with your records requests in accordance with our policies and procedures.