Need to Request a Copy of Medical Records from GLPC?

To obtain records, submit a signed and dated Authorization for Use or Disclosure of Protected Health Information to the clinic.  The form may be obtained at the clinic, or you can download an online release form at the link below (preferred and fastest way):

Great Lakes Pain Center Authorization For Release Of Medical Records Downloadable PDF

Your request is processed by MediCopy, our HIPAA Business Associate.

Some requests are processed at no charge to the requesting party (such as referrals for continuing care).  Other requests are charged a fee, in accordance with state statutes. MediCopy bills requesting entities such as attorneys, insurance companies, etc. directly; patients are not billed for this work.

MediCopy processes the requests for the requested records. Please allow 7 business days after your forms have been accepted by GLPC for processing and delivery of the invoice.

Need to Send a Copy of Medical Records TO GLPC?

New and returning patients often need to have certain medical records sent to GLPC to assist in their diagnosis and treatment.  If you need your current (or previous) provider to send your records to GLPC, a request form may be obtained at the clinic, or through this link:

Release of Info/HIPAA Form TO Great Lakes Pain Center

Do you need help with where the info should be sent? Please check with GLPC clinic staff to obtain the mailing address for where your records should be mailed.