To authorize release of your protected health information, please download and fill out the Authorization Form below. Then see the contact list below for contact information for your site of treatment. Call the site for further details for submitting the form.

Authorization Form

• Click here to download our printable information request form (Adobe Acrobat PDF format).
  

Contact List

University of Minnesota Medical Center

Riverside campus
612-273-4370

University campus
612-626-3535

Fairview Lakes Regional Health Care
651-982-7870 

Fairview Ridges Hospital
952-892-2061 

Fairview Southdale Hospital
952-924-1414

Fairview Red Wing Health Services
651-267-5551

Fairview Northland Regional Health Care
763-389-1313

Fairview Clinics
Call the site (see clinic list)