Release of Protected or Privileged Health Information

To receive copies of your medical record, you must submit by a written, signed, and dated request form.

Authorization for Release of Protected or Privileged Health Information

You may mail, fax or email* a signed request form. Or you may stop in during regular business hours to pick up a CD of your images and written reports.

Coolidge Corner Imaging
356 Harvard Street
Brookline, MA 02446

Fax# 617-383-6592.

Please give us a call if you would like to discuss options for obtaining your records. 617-383-6585

*Please note, if you intend on emailing a release back, we cannot accept an electronic signatures. Please give us a call for details.