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.

Medical Records Contact Information

Hours of Operation: Monday – Friday 9:00am – 05:00pm
Phone: 617-442-8800 x1268
Email: medicalrecordrequests@dimock.org
Fax: 617-442-4583

Request Records

To request a copy of your Dimock medical or behavioral health records, please complete the relevant authorization form:

Medical Record Authorization Forms: English | Spanish

Behavioral Health Record Authorization Forms: English | Spanish

Then 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

Then, fax your completed form to 617-442-4583 or email it to medicalrecordrequests@dimock.org.

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

Request Records In Person

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

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

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