You can download a copy of the Medical Records Release form on the link below.
You must have the form notarized in order for DataSafe to release copies of the your medical records and the original form must be mailed to DataSafe.
The mailing address is:
574 Eccles Ave.
South San Francisco, CA 94080
There will be a charge of $20 plus the certified mail cost. If you prefer to pick up a copy of your the medical records at one of the DataSafe facilities, the cost will be $20 and you (the patient) must provide a photo ID. With this option, you (the patient) are not required to have the medical records release form notarized since one of our Client Services Representatives will check your photo ID.