If you would like to submit a medical record request for Stony Brook Community Medical, P.C., or Meeting House Lane Medical Practice, P.C., please click on the following link(s) below.
Please note that different forms are used if you are the patient or if you are a patient representative making the request.
All requests will be processed within ten (10) business days of receipt of the requests.
Stony Brook Community Medical, P.C.
Online Patient Medical Request Form
Click here to submit a request as a patient. (English)
Click here to submit a request as a patient. (Spanish)
Online Patient Representative Medical Request Form
Click here to submit a request on behalf of the patient. (English)
Click here to submit a request on behalf of the patient. (Spanish)
Online Patient Attorney Medical Request Form
Click here to submit a request on behalf of the patient.
To download the Patient/Representative Medical Request Form (English) Click here.
To download the Patient/Representative Medical Request Form (Spanish) Click here.
Meeting House Lane Medical Record Requests:
Patient English
https://vra.verisma.com/api/792
Patient Representative English
https://vra.verisma.com/api/793
Patient Spanish
https://vra.verisma.com/api/794
Patient Representative Spanish
https://vra.verisma.com/api/795
Please use the following contact information if you have questions regarding medical release forms:
Email: Sbcm-verisma@stonybrookmedicine.edu
Fax: (631) 994-3301
Customer Service Phone: (866) 786-1996