Canton, Massillon & Alliance Center
The form on this page can only be used t this Planned Parenthood of Northeast Ohio health center:
Requesting Release of Your Health Information
If you change or use multiple health care providers, you should make sure they have access to your medical records so that you can get the most complete care. This doesn't usually occur on its own. If you are planning to become a Planned Parenthood client or if you want to make your medical records available to another health care provider, complete and return this form (below) indicating whether you you want us to "release" your medical records to another health care provider or "receive" your medical records from another provider. Records can't be released without this form on file.
Download Release of Information Form - PDF
|
