Medical Records Request

For information on requesting your Medical Records, please refer to the Consumer Handbook provided at Intake.

It states: You have the right to request, examine, and/or receive copies of any information used to make decisions about your care. This request must be made in writing to the Compliance Coordinator. If you request a copy, we may charge a fee to cover the cost of copying, mailing, and any other supplies related to your request. The fee is 30 cents per page, plus a $25 service fee and postage. If your request is denied, you will receive a written explanation of the denial.

After submitting your request, additional information may be required to confirm your identity for safety reasons.

How to Submit Your Request Form

All requests must come with a copy of an official photo ID (typically a driver’s license).

  • Email: Please send your request along with a copy of your photo ID to: info@achancetochange.org

  • Fax: 405-840-9017

  • US Mail:
    Mail your request, and a copy of an official photo ID, to:
    A Chance to Change
    Attn: Medical Records
    2113 W. Britton Rd.
    Oklahoma City, OK 73120     

  • In-person:
    You can complete a request with one of our front desk personnel at our facility

Typed signatures will not be accepted. All requests must be physically signed.