Evergreen Treatment Services is committed to providing excellent customer service when responding to requests for medical records. 

In order to protect our patient’s privacy and confidentiality under 42 CFR Part 2, please download the Release of Information (ROI) form below.



Fax or mail the completed form to the applicable clinic for which you are requesting records.


Seattle Clinic

1700 Airport Way South

Seattle, WA  98134-1618


PHONE: 206-223-3644

FAX: 206-223-1482

South Sound Clinic

6700 Martin Way East – Suite 117

Olympia, WA 98516-5586



PHONE: 360-413-6910

FAX: 360-413-9026

Grays Harbor Clinic

804 Levee Street

Hoquiam, WA 98550-2527


PHONE: 360-209-6339

FAX: 360-532-0731

South King County Clinic

1412 SW 43rd Street – Suite 140

Renton, WA 98057-4801


PHONE: 425-264-0750

FAX: 425-264-0799


Cost of Medical Record Copies

Records requested for continuation of care are released at no charge. Records requested for reasons OTHER than for continuation of care or follow-up care may be assessed a fee as follows:

  • A charge of $1.12 for the first 30 pages and $.84 per page for additional pages
  • Postage fees are charged for billable requests  when records are mailed and $25.00 fee, if applicable.

Because there may be a cost associated with your request, we recommend that patients determine which records are most relevant. If a fee applies, records are released when payment is received.


To learn how medical and substance use-related information about you may be used and disclosed, and how you can get access to this information, download our Notice of Privacy Practices form.