Written Requests

Requests to view or obtain a copy of your health record, or the health record of another individual, must be in written form and be submitted alongside an administrative fee.

How to submit a written request

  1. Complete the Authorization for Release of Patient Information form, either by printing it or filling it out electronically. To avoid delay, please make sure the form is filled out fully and is dated and signed by you.
  2. Submit your completed form to our Health Information Management (HIM) department by mail or e-mail. You must also include:
    • A copy of your government-issued photo identification
    • An administrative fee of $33.90 (Visit our Fees page for more information, including which forms of payment we accept.)

This authorization is valid for six months and pertains only to information that is specific to treatment received on or before the date signed.

For your protection, please note that:

  • A copy of your health record will not be released to third parties without your written authorization;
  • Health information cannot be released over the telephone; and
  • The Health Information Management (HIM) department at one hospital cannot release your health records from another hospital. For example, London Health Sciences Centre (LHSC) cannot accept a request to release health records from St. Joseph's Health Care London (SJHC).