You can request a copy of your medical file or that of your child under 14:
1. By completing and signing the following form:
2. By sending us a signed and dated letter containing the following information:
- Your first and last name (or that of your child under 14)
- Your date of birth (or that of your child under 14)
- The surname and first name of your father and mother (or the full names of the parents of your child under 14 years old)
- Your full address and a phone number to reach you
- Specify the desired documents and the date of these documents
- Mention for whom the documents are intended.
- If it is for a health professional, specify his name as well as the name and full address of the establishment where he practices.
3. By going in person to one of the service points to complete an application with the help of a receptionist.
Submit your request
- By email: firstname.lastname@example.org
- By mail: Pointe-Saint-Charles Community Clinic, Medical Archives, 500 Ash Avenue, Montreal, Quebec, H3K 2R4
- By fax: 514 937-3492
Who can sign an application?
- User aged 14 and over: signature of the user or legal representative (LSSSS art.17)
- User under 14: signature of a parent or legal guardian (LSSS art. 21)
The Medical Records Department is responsible for the protection of personal information and the preservation of user files. Know that following your request you will have access to the file as soon as possible.