Request Medical Record

If you would like a copy of your discharge summary or medical record, please print and complete this form

• English
• En Espanol

If you are under the age of 18, the form must be signed by a legal guardian. Please fax form to 914-763-0950 or mail the request to

Four Winds Hospital
800 Cross River Road
Katonah, NY 10536
Attn: Health Information Management Department

Please allow 7-10 business days for us to process your request. Any questions contact our Health Information Management Department at 914-763-8151 x2018.