Request Medical Records

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To receive a copy of your medical records, please print and complete this authorization form. Be sure to complete the form in it's entirety to avoid delays with processing your request. We will need a copy of your driver's license or a valid ID when you submit your request.

You may email this information to MeritHealthWesleyRecords@sharecare.com, fax it to (601) 296-3101 or mail your request to:
Merit Health Wesley
Medical Records
5001 Hardy Street
Hattiesburg, MS 39402

For records to be sent directly to you, please choose mail or email. For records to be sent to a provider, please choose fax or mail. Please provide the contact information for the receiving provider including address, phone and fax numbers.

If you have questions, call us at (601) 261-5877 and someone can assist you Monday - Friday, 8 a.m. to 5 p.m. You can also call 1-800-560-3800.