An authorization form is required when requesting copies of medical records for personal reasons or if you are requesting your records be made available to another party. If you need copies of your records, you may do one of the following:

1. Download, print and submit the form on this page to:
Fax: 920-320-5118
Or regular mail:

Holy Family Memorial
Attention: Release of Information
P.O. Box 1450
Manitowoc, WI 54221-1450

2. Call the Release of Information Department at 920-320-2278
You will need to leave a voice message.

Download Form

The authorization form is not valid if one or more required fields are left blank. Complete all required fields in order for your request to be processed.