To receive a copy of your medical records, please CLICK HERE to print and complete the Consent for Release of Information form. Send the completed form and a copy of your current driver’s license via email to [email protected], fax to (678) 459-3498 or mail to:

St. Dominic Hospital
ATTN: Health Information Management
969 Lakeland Drive
Jackson, MS 39216


The copy of your records will be mailed or e-mailed through CIOX Health’s secure portal.

If you need to speak directly to a CIOX Health employee regarding a request for medical records, please call 601-200-6830.