Patient Portal

Medical Records Request - Missouri

If you received care from a physician’s office located in Missouri, please download the appropriate form:

Request for information by an individual patient
Third Party Authorization for release of information
Authorized Relative Certification

Please complete the form in its entirety, and sign and date.

Mail or fax the form to:
Health Information Release Services
660 S. Euclid Ave., Campus Box 1219
Cancer Research Building, Room 112
St. Louis, MO 63110 (Map - PDF)

Fax: (844) 868-1435

Pick up in person:
Washington University Medical Records
Cancer Research Building
660 S. Euclid Ave., Room 112
St. Louis, MO 63110

Walk-in hours:
9:00 am - 11:30 am
12:30 pm - 3:30 pm