To request your medical records please download, fill out and submit our (link to form) Release of Information.

• Fill it out electronically and email it to us at info@midohiobh.com
• Print, fill out & fax it to us @ Fax:1-740-569-5737
• Print, fill out & mail it to us
• Print, fill out & bring it in person

You will need to provide the following:

Name & DOB of patient requesting records

Visit location/date, as well as description of records needed

Patient signature/witness signature (other than family)

Legible copy of photo ID