Phone: (920) 433-0111

Medical Records

To request a copy of your medical records from our Medical Records Department, download and complete the Medical Records Release Form. Once completed, attach it to the online form below, or mail to: Medical Records Department 1726 Shawano Ave., Green Bay, WI 54303. Call (920) 459-4657
for more information.

Step 1

Download and complete the Medical Records Release Form.

Download

Step 2

Submit your completed Medical Records Release Form via mail at Medical Records Department 1726 Shawano Ave., Green Bay, WI 54303, or attach in the form below.

First Name*:*

Last Name*:*

Date of Birth*:*

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