You may also complete the Release of Information Authorization form, available in English, Spanish and Portuguese. Please fax the completed form to Health information Services at 203-739-6689. Please be sure to include current address and phone contact information in case we need to reach you about your request.

Click on a Release of Information Authorization to view online or print a copy. Release of Information Authorization are available online in PDF format. You may need to download the free PDF reader from Adobe.com.

Release of Information Authorization Form

• Release of Information Authorization
• Spanish - Release of Information Authorization
• Portuguese - Release of Information Authorization
• Addendum to Release of Information - Records for Deceased Patient Form
• Spanish - Addendum to Release of Information - Records for Deceased Patient Form

If you need to change the information currently included in your medical record, please contact Health Information Services at 203-739-7218.

Patient Request to Amend Health Information

You may also complete the Patient Request to Amend Health Information form and fax to Health Information Services at Danbury Hospital at 203-739-6689.

• Patient Request to Amend Health Information

Please be sure to include current address and phone contact information in case we need to reach you in regard to your request.

Please contact us if you have any questions about medical records:

Danbury Hospital
Health Information Services
24 Hospital Ave
Danbury, CT 06810

Request Copies of Medical Records

203-739-7218
Fax: 203-739-6689
Monday through Friday: 8 am – 5 pm

Amending Medical Records

203-739-7218
Fax: 203-739-6689
Monday through Friday: 8 am – 5pm

Questions regarding any of the following topics:

Birth Certificates, Patient Portal Accounts or Requests for Radiology Images

203-739-6923
Monday through Friday: 8 am – 5 pm