To request a copy of your medical records, please download and complete the HIPAA-compliant authorization form below, then email the completed form to the address that matches your Vantage Medical Associates location.
Official NY Courts HIPAA-compliant release form (PDF). Fill out all required fields before submitting.
Download the formUse the button above to download the HIPAA Authorization Form as a fillable PDF.
Complete & signFill in all required fields. A signature is required for the request to be processed.
Email to the location you visitSend the completed form to the email address for your Vantage location listed below.
Click the email address for your location to open your email client with the address pre-filled.
16-12 Central Avenue Suite 201,
Far Rockaway, NY 11691
131-24 Rockaway Blvd,
South Ozone Park, NY 11420
2035 Ralph Ave Suite C,
Brooklyn, NY 11234
9413 Flatlands Ave,
Brooklyn, NY 11236, United States
3901 Nostrand Ave,
Brooklyn, NY 11235
160 Fourth St,
Brentwood, NY 11717
164 W Main St,
Babylon, NY 11702
3000 Ocean Pkwy,
Brooklyn, NY 11235
419 Humboldt St,
Brooklyn, NY 11211