Forms
We will gladly send your medical records to your new provider FREE of charge. Do not request your records until you have secured an appointment with your new provider. There is a fee if you would like a printed copy of your medical records mailed to you for your personal use. Download the Release of Medical Record Form, print, complete and sign. Email the form to info@womenscenterofloudoun.com or mail to P.O. Box 1756, Ashburn, VA 20146. If requesting a personal copy of your medical records, we will not mail the records until the fee has been paid.