To request a copy of your medical records by mail from or for OrthoConnecticut, patients must do so in writing using the form below, available for download.
- Please allow 5-7 business days to accommate your request.
- OrthoConnecticut may charge a reasonable fee not to exceed 65 cents a page for copying a patient’s record and will charge the costs of materials for copying x-rays.
Patients can also pick up copies of their medical record between 8:30am and 4:30pm, Monday through Friday. Front Desk Staff is required to ask and view a driver’s license that matches the name on the records release form. If someone other than the patient is picking up medical records, a signed release is required.
FOR THE NORTHERN OFFICES:
- Please complete and return the following form:
Authorization for Release of OrthoConnecticut Medical Records -
DANBURY, RIDGEFIELD & SOUTHBURY patients please return above form to Jana Pacific:
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Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
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Fax: 203-797-1817
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Mail: OrthoConnecticut, 131 Kent Road, New Milford, CT 06776. Attn: Jana Pacific, Medical Records
- Questions: please call 203-702-6666
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LITCHFIELD, NEW MILFORD & SHARON patients please return above form to Mary Kunic:
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Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
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Fax: 860-350-6291
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Mail: OrthoConnecticut, 131 Kent Road, New Milford, CT 06776. Attn: Mary Kunic, Medical Records
- Questions: please call 860-355-8000
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FOR THE SOUTHERN OFFICES:
- Please complete and return the following form(s) as required: Authorization for Release of OrthoConnecticut Medical RecordsAuthorization for Release of Medical Records to OrthoConnecticut
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DARIEN, NORWALK & WESTPORT patients please return above form to Valerie Leone:
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Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
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Fax: 203-847-1940
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Mail: OrthoConnecticut, 761 Main Ave., Suite 115, Norwalk, CT 06851. Attn: Valerie, Medical Records
- Questions: please email This email address is being protected from spambots. You need JavaScript enabled to view it.
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