You may request a copy of your medical record by completing and submitting an authorization form. A picture ID is required at the time of the request.
Click here to download the authorization form
- In person at the Release of Information department located at the address below from 8am - 5pm, Mon - Fri.
1 Prestige Place, Suite 540
Miamisburg, OH 45342
- By phone - (937) 762-1200
If your form was obtained here, please fax to (937) 522-8444.
Please allow 10 business days to process your request. If the requested information is located off-site or the authorization form is not properly filled
out, additional time may be required to process your request.
If your request requires a fee, you will be notified of the fee before the record is sent.
You can also activate your Kettering Health MyChart account to securely access portions of your medical record online. You may do so by visiting
- To be granted proxy access to a family member's MyChart account, please print and complete the MyChart Proxy Access Consent Form and mail or fax back to the Release of Information Department. You will be contacted by Information Systems once your proxy access has been granted.