Medical Records Request

Request your documents from Asheville Detox by filling out this quick medical records form. Asheville Detox strictly enforces our patients’ privacy and will be in contact to ensure that the person requesting records is allowed to receive them. If you have any questions, call us! We are here to help.

"*" indicates required fields

Name of Client*

First Last

Name of Person Requesting Records*

First Last

Phone*

Email*

Consent*

I have read, understand, and agree to Asheville Detox's policies concerning release of medical records.