• decreaseincrease
  • pdf

Medical Records Release Form

The following forms provide authorization to release or obtain medical information.

If you are a patient requesting medical records, click here to download the form.

If you are a provider requesting medical records, click here to download the form.

You may get the form to us in one of four ways:

1) Email completed Release of Information request form to ROI@wregional.com

2) Fax completed form to 479.463.1239.

3) Mail completed form to:

Washington Regional Medical Records
3215 N. Northhills Blvd.
Fayetteville, AR 72703

4) Deliver the completed form in person to the address listed below:

Washington Regional Medical Records Department
3318 N. Northhills Blvd., Ste. 110
Fayetteville, AR 72703

For questions, call 479.463.1158.