Request Medical Records

Request Medical Records

The Medical Records Department at The Dimock Center is dedicated to maintaining your medical records and keeping your health information private and secure within federal and state regulations.

Dimock Medical Records Department Contact Information

To request a copy of your Dimock medical records, please complete the appropriate authorization form below and fax it to 617-445-4583:

Authorization form for Medical Records: English | Spanish

Authorization form for Behavioral Health Records: English | Spanish

Complete the following required fields to properly execute your request:

  1. Patient’s full name (include maiden name, if applicable)
  2. Address and telephone number
  3. Date of birth
  4. Email address
  5. Date of service
  6. Requestor* information where medical records are being sent
  7. Sign and date the completed authorization form

*The requestor must be a patient or the patient’s guardian/legal representative.

You may also request a copy in person at the address below; if you are picking up your medical records, please bring your photo identification.

      • The Dimock Center
      • Medical Records Department
      • 45 Dimock Street
      • Roxbury, MA 02119

The Dimock Center will complete all records requests within 30 days. Please note that copy fees may apply for medical records except for patients and healthcare-related facilities.