Patient Forms and Medical Records

To make it easy for you to request your medical records or preregister for hospital services, including maternity services, you can access the necessary forms by following these instructions.

Medical Records Release

Please download, print, complete and return the Authorization for Release/Exchange of Information form (below) to obtain or send copies of your Saint Mary’s Hospital medical records.

Return the completed form to our Release of Information staff via fax, mail or deliver it in person: 

Fax to: (203) 709-3420

Mail to:

Release of Information
Health Information Management Department
Saint Mary’s Health System
56 Franklin Street
Waterbury, CT 06706

Deliver in person

From the hospital’s main lobby, take the first hallway to your left. The Release of Information office is located five doors down on the left just past the chapel

For questions or to check on the status of a pending request, please call (888) 252-4146 and select Option 1 or e-mail:

Pre-Registration Forms

Find our online Pre-Registration Form here. For more information on registration, please see the Admissions page.

Patient Rights & Responsibilities Brochures

Please see the Admissions page. 

Advance Directives

Please see the Advance Directives page.

Saint Mary's Hospital

Saint Mary's Hospital
56 Franklin Street
Waterbury, CT  06706
(203) 709-6000

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