request medical records

Obtain a Copy of your Medical Records

To obtain a copy of your medical records, download and complete the Authorization to Release Medical Information form. The completed form requires a notarized signature.

to receive your medical records by mail

The notarized form and any supporting documentation can be sent to:

Emergent Health Partners
Attn: Michelle Knott
1200 State Circle
Ann Arbor, MI 48108


Fax: 734-477-6776

to receive your medical records in person

Make an appointment for medical records pick-up with Patient Accounts Representative, Michelle Knott.

Bring the notarized form, any necessary supporting documentation, and a valid driver’s license or State ID to our Ann Arbor office.

Michelle Knott
Phone: 734-477-6366