Looking to obtain a copy of your medical records?

You may request the release of your medical records by printing and completing the following form:

Download Forms


Medical Records Release

English


Upon completion, choose one of the following options:

Mail

HIM Department Dominion Hospital
2960 Sleepy Hollow Road
Falls Church, VA 22044

Fax

(703) 531-6139

Be sure to complete, initial, and sign where appropriate on the form. When requesting behavioral health records, patients 14 years of age or older must also sign the form. Incomplete forms will be returned. The average processing time for requests is ten business days.

For additional information, or to check on a status of a previous request please call (703) 531-6105 or toll free at (877) 302-7338 .

If you need translation services, please contact the facility Health Information Management (HIM) Department at: (703) 531-6105.

The offices are open 8:00 am through 4:30 pm, Monday-Friday.