Patient Records

How to Request Medical Records

Option 1: Request records from Clinical Support Services
Please email Kena Pickett or Charlene Green.

Option 2: Request medical records by mail
To request a copy of your medical records, download the forms below and mail them to the appropriate facility. Please be advised there may be a cost involved for this service.

Authorization to Use Form
Treatment and Financial Agreement

Mail completed form along with copy of photo ID to:

Hampton University Proton Cancer Institute
40 Enterprise Parkway
Hampton, VA 23666