Departments & Services >>

How to Obtain Copies of Your Medical Record

To request a copy of your record, download and print the "Authorization For Release of Information" form below.

Complete the form and fax or mail to the Medical Records department:

The New York Eye and Ear Infirmary
Medical Records Department
310 East 14th Street
New York, NY 10003
TEL: (212) 979-4352
FAX: (212) 353-5782

There is a charge of $ .75 per page if record is being copied for the patient. If the record is being sent to a doctor, there is no fee.

Please note: New York State law specifies a 7 year period for retention of medical records for an adult patient, and to age 21 for minors.  

Authorization Form

• Authorization Form - English
• Authorization Form - Spanish
• Authorization Form - Russian
• Authorization Form - Chinese

Home > Departments > MEDICAL RECORDS