Instructions:
If you do not wish to submit your request directly through Sharecare, please fill out both forms in their entirety and return them to NCF to request a copy of your medical records.
- Request Medical Records Instructions (PDF)
- Authorization to Release PHI
- Authorization to Disclose PHI
- Authorization Form (PDF option)
To open and view the PDF forms above, download the free Acrobat Reader.
Release of Health Information
NEUROLOGY CENTER OF FAIRFAX has partnered with Sharecare to fulfill your requests for records.
NEUROLOGY CENTER OF FAIRFAX is committed to protecting your medical information. For information about your rights and the obligations you have regarding the use and disclosure of your medical information, please see our Notice of Privacy Practices.
If you are our patient and would like to request your medical records, please click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID.
If you are unable to complete the electronic form above, please use our webforms below to complete your request. Please note the processing of records is faster using the online form above.
Only the patient, parent/legal guardian, or the patient’s legal health care representative can sign the form to release medical records. If you are requesting records on behalf of the patient or as the patient’s representative, please use the links below and provide the appropriate authorization documentation.
ShareCare FAQs
When will my online medical record request be ready?
Your records will be ready in 3-5 business days from the receipt of your electronic request.
How do I check the status of my request?
Go to https://recordstatus.sharecare.com
How do I pay for my records and/or radiology images?
Go to: https://payonline.hds.sharecare.com/
How do I contact Customer Service?
You may call: 858-244-1811
Or
Contact Support for live chat: https://hds.sharecare.com/contact-us/