To obtain a summary of your medical record or a specific document from your medical record, you must:
1. Submit a signed written request using one of the forms below.
2. Send your request to our medical records department:
- Email: archives.clscvalleyfieldbeauharnois.cisssmo16@ssss.gouv.qc.ca
- Fax: 450 371-4910
Mail: Archives médicales - Clinique externe de santé mentale
11, rue de l’Église, bureau 220 Salaberry-de-Valleyfield (Québec) J6T 1J5*Please note that you can also submit a written request at the clinic front desk.
Request forms
- For requests concerning a deceased person, click here.
*Don’t forget to include all required documents.
- For any other request, click here.
IMPORTANT: Make sure to fill out all fields, and sign and date the form |
All requests concerning a person under the age of 14 must be signed by the mother OR the father OR the legal guardian. In compliance with the Act respecting Access to documents held by public bodies and the Protection of personal information, a fee is payable in advance for certain services.