COVID-19 Update:

PORT Health continues to strive to meet the needs of our patients through this difficult time. Even though COVID is still a threat, we are now giving our patients the option to have their appointments face to face with their provider. The option for remote appointments remains, however, if you prefer to be seen in the office, you are welcome to come in. Please note that you will be required to wear a face-covering that covers the mouth and nose, maintain social distancing and your temperature will be taken as you enter. Please call ahead of your appointment and let us know which option you choose. Emergency walk-in patients will also be seen face to face if so desired.


Additional COVID-19 Information

Medical Records Request

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Instructions for Requesting Medical Records

PORT Health Services has a process for patients or their personal representative for requesting in writing:

  • Copies of their medical record
  • That their medical record be sent to another individual or entity


For requesting a copy of your Medical Record:
Read carefully the form “Medical Records Request”. Complete the top section ONLY. It is essential that you list your current and accurate contact information and check all applicable boxes.

Submission Methods: You may submit this form in person or mail it to the clinic where you receive services.


  • A flat fee of $5.00 (for labor and supplies) is charged for paper copies and postage, if mailed.
  • A flat fee of $6.50 is charged for electronic requests.
  • A flat fee of $10.00 is charged for a treatment summary along with postage, if mailed.


For requesting a copy of your Medical Record to be sent to another individual, entity, or other healthcare provider:
Complete the form “Authorization for Use and Disclosure of Protected Information”. Please ensure that all necessary information is provided along with signature(s) and date(s) for PORT to process your request.

Submission Methods:

  • You may submit this form in person to the clinic where you receive services.
  • Mail form to:
    • PORT Health Services
      Attn: Medical Record Release Office
      154 Beacon Drive, Suite I
      Winterville, NC 28590
  • Fax it to 1-888-856-3428


  • Reasonable, cost-based charges will apply according to applicable statutes and PORT policies.
  • There is no charge for sending your medical records to another healthcare provider.

Please note: Only complete forms with valid consents will be processed in accordance with applicable laws and PORT’s policies.

For questions regarding record releases, you may call 252-353-1114 and ask to speak to a Record Releases Associate.