Submitting a Request
To request a deceased patient’s record, please fill the following form out:
- Authorize for Release of Information on Deceased (PDF)
Please send the completed form to the following address or fax number:
SOUTHWESTERN VIRGINIA MENTAL HEALTH INSTITUTE
Attn: Health Information Management Department
340 Bagley Circle
Marion, Virginia 24354
Fax Number:
276-783-1247
Adobe Reader is required to view this form.