Medical Records Request

How to Request Your Medical Record

Requesting to have your medical records released is quick and easy.

Authorization forms

Please Note

In accordance with Wisconsin State Statutes, there is a copying charge for medical records.

For more information, please  call (262) 696-5855.

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  1. Fill out the Authorization to Release Form.
  2. Sign the form.
  3. Mail us the form:

    Please send your form to the ProHealth Care entity from which you are requesting records. To find mailing addresses for all of our sites, visit Our Locations.

For more information