Get in touch

If you're a patient or past patient of Hermitage Clinic and would like a copy of your medical records, please fill out this online form.

Please tick below if you need to request records from any of the following departments:

In order for us to verify your identity, we’ll follow up with an email asking you to provide a copy of one of the following. Please tick the document you intend to provide:

Records can be sent to your address or via secure, encrypted email to the email address provided in this form. Please specify how you wish to receive your records: