Medical Records

Give permission to share your medical records.

Medical Records

Share Your Medical Records

Complete this form to give us permission to share your medical records, or to let another provider share your records with us.

Release of Information – Send Records to Another Provider

Need to have us send your medical records to someone outside of Tapestry 360 Health? Please fill out the Release of Information Form.

Form Instructions

You can return the forms to us in any of the following ways:

  • Drop it off at your closest clinic location. Our staff will fax it to the appropriate department.

  • Fax it to our Medical Records Team at 773-437-6812

  • Mail it:
    Tapestry Health 360
    Attn: Medical Records (ROI form)
    845 W Wilson Avenue, Chicago, IL 60640

We will also need a copy of your government-issued ID, like your state ID, driver's license, etc., please bring or send a copy with your release form. For additional questions, please call Medical Records at 872-260-3852.