Cost
A base fee prepayment of $17.19 plus $.58 per page for the first 100 pages and $.30 after 100 is required for copies of medical records.
Address
Send completed form or signed letter to:
Medical Records
Lahey Clinic
41 Mall Road
Burlington, MA 01805
For other Lahey Clinic mailing addresses, click here
Instructions
To process requests for medical records, Lahey Clinic needs either a signed form or letter. Either will suffice as a request for medical records.
- Download and complete the Authorization For Release of Medical Information form.
OR
- Send a signed letter with the following information:
- Name
- Address
- Date of Birth
- Telephone Number
- Lahey Clinic Number (if known)
- Purpose of the Request
- Type of Information Requested
- Where to Send the Medical Record
- Signature
