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Medical Records Release

In order for Grand Peaks to request medical records on your behalf, a Patient Authorization for Use and Disclosure of Protected Health Information Form (Medical Records Release) will need to be completed.

Please complete and sign the form

You may return this form to either one of our Grand Peaks locations, fax to the number on the form, or
email to one of our clinics listed below.

Medical & Pharmacy:  medical@grandpeaks.org   
Dental: dental@grandpeaks.org 
Behavioral Health:  behavioralhealth@grandpeaks.org   

If you have questions, please call us at (208) 356-4900.

Medical Records Release - English
Medical Records Release - Spanish
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72 S 1st E Rexburg, ID 83440
(208)356-4900
335 E Main St St. Anthony, ID 83445
(208)624-4100
Contact Us
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This health center receives HHS funding and has Federal Public Health Service deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and for its covered individuals.

Copyright ©2023 • Grand Peaks Medical Dental Behavioral Health, All Rights Reserved.

For after-hours assistance please call (208) 356-4900 and you will be assisted by our after-hours answering service.  For emergencies, please call 911.

Upper Valley Community Health Services, Inc. DBA Grand Peaks Medical Dental Behavioral Health and Pharmacy is a 501(c)3 nonprofit organization. Grand Peaks complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Anti-discrimination Notice. Call (208) 356-4900.

Para ayuda después del horario de atención por favor llama (208) 356-4900 y nuestro servicio fuera del horario de atención le ayudara. Para emergencias por favor llama al 911.

Upper Valley Community Health Services, Inc.  DBA Grand Peaks Medical, Dental, Behavioral Health and Pharmacy es una organización sin ánimo de lucro tipo 501(c)3. Grand Peaks cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (208) 356-4900.