Records Request Form

To request the release of Medical Records, please complete the Consent for Release of Confidential Information form. The form must be completed in its entirety, to include the client signature and date. The form can be uploaded to this request or indicate in the request form that a Consent Form has already been completed by the client. Any individual requesting a copy of records, including the client themselves, must also upload a copy of their driver’s license or other form of identification for verification purposes.

If requesting your own personal records, your records can be emailed to you (records will be encrypted), mailed to you, faxed or left at the front desk at our main office to pick up at your convenience. The main office is located at 3450 Buschwood Park Dr., Suite 345 in Tampa, FL 33618. In addition, ACTS has launched our Patient Portal that can be accessed via our website. As a result, you can easily and securely access some of your treatment information online. To sign up, you will need to provide a valid email address. You will then receive an email to complete the registration process.

The charge for the printing of records is $1.00 per page for the first 25 pages and $0.25 (25 cents) for each page thereafter, plus postage. Upon processing of your request, an invoice will be sent electronically or by mail, depending upon the information you have provided. Upon receipt of payment, records will be provided. There is no charge for the electronic release of records.

The typical processing time for the release of medical records is two weeks, depending upon the volume of requests received. If you have any questions, please contact [email protected].