Home > Our Services > Center for Pain Medicine > Medical Records Information Anticoagulation Clinic Bariatric Surgery Cardiology Heart Attack Symptoms Patient Preparation Center for Pain Medicine Our Services Providers / Staff Locations Medical Records Information Emergency Services Endocrinology Gastroenterology Infusion Center Reiki Therapy Services Laboratory Neurological Studies F.A.S.T. Stroke Preparedness Occupational Medicine Orthopedics Own the Bone Joint Academy Pharmacy Radiology Respiratory Services Sleep Medicine Common Sleep Conditions STOP-Bang Assessment Medical History Form Maps and Directions Surgical Services Therapy Services Treatment Information Locations/Contacts Neurosurgery Urgent Care MEDICAL RECORD REQUESTS: Please print, complete, sign and date the Release of Information Authorization form: Release of Information Authorization Form A copy of your Driver’s License/ State Photo I.D. is also required. You may either fax or bring in your completed and signed ROI Authorization form AND a copy of your Driver’s License/ State Photo I.D. to: Fax: (330) 926-9432 Address: Center for Pain MedicineWestern Reserve Hospital1900 23rd StreetCuyahoga Falls, OH 44223 You will receive a phone call when your request is complete. a. Please be aware that a charge may apply to your request; we will inform you of this when we call you. b. If you are having someone else pick up your records for you, please either include that information on your signed authorization or have your representative bring in a signed/dated note from you authorizing them to retrieve your records. They must also bring their photo ID. You will receive a phone call if your authorization is unsigned or otherwise incomplete and/or if we are unable to complete your request. If you have any questions, please call us at (330) 971-7246.