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Premise Health has partnered with MediCopy Services for the release of protected health information (PHI), otherwise known as medical records. Please forward requests for Premise directly to MediCopy for processing. Once MediCopy receives a completed authorization (and request letter when needed), records will be released to the requesting parties. Please see below for methods to request records:

Non-Patient Requestors:

In order to request medical records please email a PDF version of the request for records named after the patient (FIRST LAST) and a signed HIPAA-compliant patient authorization to Please make sure you include your contact information, the patient information, where the records are going and what records are to be sent in the request letter.


To request a copy of your medical records, you need to provide a written request. You can complete a request form we have provided by following one of the options below. If the patient is a minor, or unable to sign an authorization, the signature of an authorized legal guardian is required. Once your request is submitted, please allow two business days before calling to check status. 

For online submission:  
Fill out an online request by clicking here. The request form will open in your internet browser. If you need to refer back to this page please right-click to open in a separate tab. Please note that a valid email address is required when submitting an online request and to complete the submission process, you must check your email and verify your request for medical records. 

To email your request: 
Please download the request form here. Once you have filled out your request in its entirety, you may securely email it directly to MediCopy at Emailed authorizations require a physical signature. 

To fax your request: 
Please download the request form here. Once you have filled out your request in its entirety, you may securely fax it directly to MediCopy at 833-418-1957.

To mail your request: 
Please print a request form here. Once you have filled out your request in its entirety, you may mail it directly to MediCopy at:

MediCopy Services, Inc. 
8 City Blvd., Suite 400 
Nashville, TN 37209 


Please note that if records are being mailed, it may take a few additional days for them to arrive. If you have requested to have your records emailed to yourself or another entity, the provided email address will receive a secure, password-protected link to your records. For security purposes, this link will expire, so please be sure to check your email regularly, and always check your spam folder!