Waterloo Regional Health Network (WRHN) emergency departments are here for serious and urgent health concerns. For other care needs, there may be options that can connect you with the care you need sooner.
Your health always comes first. Find the right care, in the right place, at the right time.
If you want a copy of your health records, you can contact the Release of Information Office. You will need to send a form with your signature that says which records you want. This form is called the Patient Authorization Form.
Please review this guide before filling out and sending us your form.
To fill out your form, you will need:
Please include the following when you fill out the form. If your form is missing information, we may not be able to give you your records.
Please include the patient’s:
Tell us exactly which records you need. Include the:
The more specific you are, the faster we can get you your records.
Include this information about the person or organization who will be getting the records:
The patient or an authorized representative must sign the form to give us permission to share the patient’s health records. This includes:
A witness needs to watch the patient (or authorized representative) sign the form.
A witness must also sign the consent form. This confirms that they watched the patient (or authorized representative) sign the form.
The witness cannot be the patient or the person signing the authorization. It must be someone else.
We cannot process your request if:
Include a clear copy of one valid government-issued photo ID, such as your:
We cannot process requests without photo identification.
If you are signing for the patient as an authorized representative, include documents that confirm you are legally allowed to do so. Some examples include:
Before you send us your form, make sure:
Missing information will make it take longer to get your records.
If you have questions before you send in your form, email the Release of Information Office for help: