It is the goal of Hampton Family Practice to protect your privacy and your medical information.  If you want some or all of your medical records to be copied and released you must complete a Medical Records Request form.  You may print the form below and bring it to our office.  You will need to sign the form in the presence of a staff member to ensure the protection of your medical information.

We charge the following fees:

Handling and Processing Fee: $10.00

1-50 pages: $0.50 per page

Additional pages: $0.25 per page

All fees must be paid in advance.

Keep in mind, there is a 7-14 day turn around for copying medical records. We will contact you when your records are available for pick up at our office.  You will be asked to show your picture ID for pick up.

Note:  If you have not picked up your copy within 30 days of our notification, we will return the copy to storage. Should you come in to pick up the copy after it has been returned to storage, an additional $5.00 retrieval fee will be charged.

By State law, the medical record is the property of the medical practice. We will only release copies of your medical information.  We do not release original documents.