Requesting a Copy of Your Medical Records


Download and print the Authorization Form for Release of Medical Records and Information.

To request medical records, please complete the form below, making sure to include a daytime phone number and the patient’s signature, and mail, fax, or drop-off to:

Authorization to disclose health information


Coffee Regional Medical Center

Attn: Health Information Services – Release of Information

1101 Ocilla Road

Douglas, GA 31533

Phone Number:  912-384-1900 and choose option # 3

Fax Number:  912-389-2105