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  • 888-305-2997
  • Who We Serve
    • Ages 10+
    • All Genders
    • Families and Loved Ones
    • Athletes
    • LGBTQ+
    • The Jewish Community
  • What We Treat
    • Anorexia Nervosa
      • Anorexia Symptoms and Signs
      • Potential Causes of Anorexia
      • Anorexia Health Risks
      • Anorexia Diagnosis
      • Anorexia Treatment
      • Anorexia Online Quiz
    • Bulimia Nervosa
      • Bulimia Symptoms and Signs
      • Potential Causes of Bulimia
      • Bulimia Health Risks
      • Bulimia Diagnosis
      • Bulimia Treatment
      • Bulimia Online Quiz
    • Binge Eating Disorder (BED)
      • Binge Eating Disorder Symptoms and Signs
      • Potential Causes of Binge Eating Disorder
      • Binge Eating Disorder Health Risks
      • Binge Eating Disorder Diagnosis
      • Binge Eating Disorder Treatment
      • Binge Eating Disorder Online Quiz
    • ARFID
      • ARFID Treatment
    • OSFED
      • OSFED Treatment
    • Orthorexia
      • Orthorexia Diagnosis and Treatment
    • Co-Occurring Disorders
      • Diabulimia
  • Treatment Programs
    • Inpatient Eating Disorder Treatment
    • Residential Eating Disorder Treatment
    • Day Treatment
      • Virtual PHP
      • In-person PHP
      • Virtual IOP
      • In-person IOP
    • Specialty Virtual Programs
      • LGBTQ+ Affirming Treatment
      • ARFID IOP
      • GOALS IOP for Athletes
      • Free to Be
      • B’SHALOM for the Jewish Community
    • LGBTQ+ Affirming Treatment
    • Support Groups
    • Integrative Therapies
  • Locations
    • Massachusetts Locations
      • Dedham – Center for Recovery
      • Dedham – Inpatient
      • Dedham – Residential
      • Braintree
      • Peabody
      • Waltham
      • Westborough
    • Connecticut Locations
      • Middletown
    • Georgia Eating Disorder Treatment Locations
      • Alpharetta
      • Dunwoody
      • Dunwoody – Residential
  • Admissions
    • Admissions Process
    • Walden Patient Intake Form
    • Insurance & Fees
    • Discharge Planning
    • For Patients
      • Frequently Asked Questions
      • Patient Resource Library
    • For Families
      • Frequently Asked Questions
      • Family Testimonials
    • For Professionals
      • FAQs for Professionals
  • About
    • Walden’s Promise To You
    • DEI Commitment
    • Our Leadership
    • Accreditation
    • Blog
    • News & Events
  • 888-305-2997

Medical Records

Request your medical history from your treatment and time with Walden

Authorization Forms

Authorization to Release/Disclose PHI
Amendment of PHI

1. Complete the authorization form. Please complete the following required fields properly to process the request:

  • Patient’s full name (include maiden name, if applicable)
  • Address and telephone number
  • Email address
  • Date of birth
  • Medical record number, if available
  • Date of service
  • Provider name or facility or clinic name requesting records from

Identify the method for us to share the requested medical records by clearly indicating the mailing address, fax number, email address

2. Sign and date the completed authorization form.
3. Fax or mail your request with all required information included.

Release of Information Fax: 781-647-0215
Mailing Address:
Walden Behavioral Care
Medical Records
10 Carematrix Drive
Dedham, MA 02026

Important Reminders

Do not e-mail this request. We cannot guarantee security of all Personally Identifiable Information included in the form if submitted via e-mail.
Additional authorization may also be required for the release of specifically protected or privileged information. Certain information can take up to 30 days to process.
For Release of Information questions, please call Customer Service at 781-647-6782.
For Audit-related questions, please call 781-647-6704 or fax 781-647-0215.

HIPAA Privacy Policy | Walden Eating Disorders

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Walden Behavioral Care

51 Sawyer Road, Suite 510
Waltham, MA 02453
888-305-2997

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