Please print, complete, sign and date the Release of Information Authorization form:

Release of Information Authorization Form - PDF

You may either fax, email or bring in your completed and signed authorization form:

Fax: (330) 971-7087


Medical Records Dept.
Western Reserve Hospital
1900 23rd Street
Cuyahoga Falls, OH 44223

You will receive a phone call when your request is complete and ready for pick up.

  • Please be prepared to come into the Medical Records Department to pick up your records
  • Please bring your photo ID with you
  • Please be aware that a charge may apply to your request; we will inform you of this when we call you
  • 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) 971-7414.

As of April 18, 2016, the Western Reserve Hospital Medical Records Department only has access to records dating from June 24, 2009 to present. Any records relating to care provided by Cuyahoga Falls General Hospital prior to June 24, 2009 are now retained by the Summa Health (SH) Medical Records Department. You may contact them directly for these requests at (330) 375-3930. We apologize for any inconvenience. If you have any questions, please contact us directly via your preferred method of communication (options above). Thank you for your understanding.