Medical Records Request

To request medical records, please submit a signed record request to our Medical Records department.

Where to find our form:

1. Online via printing the form at this link.
2. In person at the facility
3. Contact our records department at 217-373-1740 to have the form faxed or mailed to you.

Where to return the form:

1. Mailing address:
   The Pavilion Behavioral Health System
   Attn: Medical Records
   809 W Church St.
   Champaign Il, 61820
2. Via fax: 217-373-1767

Special Notes:

Authorizations expire one year from the signature date unless otherwise specified. Authorizations for the records the facility maintains must all include a witness signature. Please call the Medical Records department with any questions at 217-373-1766.