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Patient Medical Record Request Form

Please fill out the form below to request a copy of your medical records. Your request will be forwarded directly to our medical records department, and records will be provided within 7-10 business days.

Address

1033 W Germantown Pike
Norristown, PA 19403

Call us

(610) 539-8500

Email us

medicalrecords@vfmc.net

Let's Chat

(610) 539-8500

Patient Info

Full Name

Phone Number

Birthdate

Request Details

Type of Records Requested

Reason For Request

Preferred Delivery Method

AuthorizationI hereby authorize Valley Forge Medical Center to release the patient’s medical records to me as the authorized representative. I understand that fees may apply for the processing and delivery of records and that this request will be processed in accordance with federal and state regulations.As the authorized representative of the patient, I am submitting documentation proving my legal authority to act on behalf of the patient (e.g., power of attorney, legal guardianship, or other relevant authorization). I also understand that a release form signed by the patient must be provided along with this request.

Thank you! Your submission has been received!

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Address

1033 W Germantown Pike
Norristown, PA 19403

Call us

(610) 539-8500

Email us

admissions@vfmc.net

Let's Chat

(610) 539-8500

Visit Us

1033 W Germantown Pike
Norristown, PA 19403

VFMC is accredited by CIHQ. Patients have the right to file complaints regarding quality of care concerns or safety issues to CIHQ. Concerns my be communicated to CIHQ directly:

Online: https://cihq.org/complaint

Mail: Center for Improvement in Healthcare Quality
P.O. Box 3620 McKinney, TX 75070
Attn: Chief Executive Officer

Phone: 512-661-2813