Medical Records

Medical Records Request Form

To submit a new request for therapy records or psychiatry records for care provided at the Center for the Treatment and Study of Anxiety, please complete the Medical Records Request Form and scan it (or photograph it in high resolution) and email it back to us at Tiona.Combs@pennmedicine.upenn.edu. Please follow the instructions below to ensure proper completion of the form:

• Check CPUP/CCA Outpatient Practice: CTSA or COTTAGe (depending on which clinic you were seen in)
• Complete the name/address for who you want the record released to (e.g., yourself, law firm, school, etc.).
• Under Special Records, Select "Yes, Disclose" under Psychiatric Care/Treatment for records to be released
• If you would like the typical set of psychology notes that we keep, select Progress Notes, Clinic Notes, Itemized Billing Record, Other: Psychiatric Evaluation
• Complete the purpose of the requested information and the preferred delivery method