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How to request Medical Records:

To request a copy of your medical records be sent to a 3rd party (Your primary care physician, your attorney, your child’s school, etc) please fill out the form with the client’s information, who the information should be sent to, print out the form and initial the items you would like sent.

Your signature, a witness signature and signature date are required. If you would like a copy of your record, please be advised there is a cost for copying the record. Fill out the release as outlined above, someone from the records department will call you with the cost before copies are made. 

Please note that once we receive the release of information form, the records will be sent within 7 to 10 days.

The form can be faxed to 765-668-6718 or mailed to:

Grant Blackford Mental Health
505 N. Wabash Ave
Marion, IN 46952

For additional information please call 765-662-3971 and ask for Service Records.


Release of Information Form

Please note that Adobe Reader is required to fill out this form. If you do not have Adobe reader on your computer it can be downloaded here.


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