Carolinas HealthCare System
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Patient Information for Piedmont GYN/OB

Piedmont GYN/OB New Patient Letter (PDF)Patient Forms

Please print, complete, and bring the following forms to your next appointment:

Request for Medical Records

Please include the following information:

  • Patient's name
  • Patient's date of birth
  • Patient's Social Security number
  • Name and complete address of where information is to be sent
  • Dates of service and type of information to be sent
  • Patient or guardian signature and date
  • Name and telephone number where you can be reached
  • Reason for request

Please mail or fax your written request to:

Piedmont GYN/OB–Ballantyne
Attn: Medical Records
15110 John J. Delaney Dr.
Suite 100
Charlotte, NC 28277
Fax: 704-512-5101
Piedmont GYN/OB–Rock Hill
Attn: Medical Records
200 S. Herlong Ave.
Suite F
Rock Hill, SC 29732
Fax: 803-324-3908
Piedmont GYN/OB–Steele Creek
Attn: Medical Records
13640 Steelecroft Pkwy.
Suite 240
Charlotte, NC 28278
Fax: 704-583-2212

Requests will be processed in seven to 10 business days; a processing fee may be charged.

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