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
Address:Medical Records Dept.Western Reserve Hospital1900 23rd StreetCuyahoga Falls, OH 44223
You will receive a phone call when your request is complete and ready for pick up.
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.