Medical Records Request

All persons requesting medical records must sign a Release of Information (ROI).

If you would like CPS to send your records to another provider, send a completed ROI to our office.  Please include the providers Name/Agency and a fax number.  

If you would like your records to be given to you directly, the release needs to be completed with your information in the Name/Agency section. If you are a current client, you will need to set up an appointment to meet with a case manager in order for the records to be provided. If you are no longer receiving services at CPS due to graduation, transfer of care, or termination of services, your records can be mailed to you or you can come by the office to pick them up.

Students may provide the Release of Information via

  • fax 470-578-9102, Attention: Medical Records Team,
  • email (cpscasemanagement@kennesaw.edu), or
  • in person to either CPS campus locations.
    Please understand that because email communication can be easily accessed by unauthorized people, your privacy and confidentiality cannot be guaranteed when this medium is utilized.

Please allow 5-7 business days for request to be processed.  

Consent Authorization to Release Information (ROI) form

©