Medical Record Release Forms

Valley Health Systems keeps a private, secure medical record about your health. To authorize others to view and manage your medical records, or to authorize Valley Health to obtain your medical records from another institution, complete the appropriate form below and return to Valley Health. Here is how you can submit your completed form:

• Upload the form to the My Valley Health Patient Portal
• Fax an electronic copy the form to our Business Office at 304-399-3236
• Mail a hard copy of the form to Valley Health Medical Records C/O Business Office at PO Box 1680, Huntington, WV  25717

General Medical Release Form

Behavioral Health Release Form