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Request Your Medical Records + -

In response to the Coronavirus (COVID-19) pandemic, Chesapeake Regional Healthcare has updated its hospital visitation policy. As a result, the Health Information Management Department is no longer open to the public. To receive a copy of your medical record, please complete the fillable release form below and send it back to our office. 

You may email, fax or send the completed form using the information listed below. Please ensure that you provide your full name, date of birth, the last 4 digits of your social security number (SSN), indicate the specific records needed, and how you want the records to be delivered to you. If you would like to receive your medical records electronically, you’ll also need to provide your current email address.

Forms

  • English: Download
  • Spanish: Will be available soon.

Please send to:

Health Information Management
Release of Information
736 Battlefield Blvd., North
Chesapeake, VA 23320

Fax: 757-312-6169

Email to: ReleaseOfInformation@chesapeakeregional.com

If you have questions, please call 757-312-6114.

Please check-out our COVID-19 updates page for more information.