Release Form
Download the release form you need to request your images.
Our Image Service Center can provide images and reports for imaging exams at Mass General.
The Image Service Center sends digital images by CD or DVD to your referring provider. You can use these instructions to ask for a copy of your images and the radiologist's report. If you only want a copy of the radiologist's report, you can contact Mass General Medical Records at 617-726-2361.
All requests need signed release forms: the Authorization for Release of Medical Images and the Authorization for Release of Protected or Privileged Health Information (PHI).
Tips for Filling Out the Release Form
On the Authorization for Release of Protected or Privileged Health Information form, if you'd like to send images to your provider, please write their name and address in the "TO" box. If you'd like to have the images sent to yourself, leave the address blank.
You can also get our release form in Spanish. Download PDF >
Ordering Your Images
You can ask for your images online or in person at our office in Boston. We will give you a CD with both your images and the radiologist's report.In Person
- Visit our office in Room 0029 of the Blake Subbasement in the Blake Building on Mass General's main campus in Boston
- Fill out and sign the release form.
Online
- Submit the online order form for patients. You can request to pick up your images in person or have them mailed to you. (Use this form for internal requests only.)
- Print a copy or make note of the reference number on you order.
- Expect a call from our staff when your images are ready for pick up.
Submit Form
Getting Your Images
You, a family member or friend can pick up your images in person at our office in Boston. Or you can get them by mail. Here's what you need.In Person
- Photo ID
- The signed release form
Friend/Family
- Photo ID
- Written permission from the patient to pick up images
- The signed release form
- Name of images being picked up such as MRI, CT or mammogram
By Email
- You send a signed note with your information including your name, date of birth, mailing address and scan it to the Image Service Center via email. Please email this information to imagetransrequests@partners.org.
By Mail
- The signed release form mailed, overnighted, faxed or emailed to the Image Service Center. If you choose to have the images overnighted, we will ask for credit card information over the phone.
Our Mailing Address
Image Service Center
Massachusetts General Hospital
55 Fruit Street, Blake Building
Blake Subbasement 0029
Boston, MA 02114
And in case you want to fax us: 617-724-0264
Email: imagetransrequests@partners.org
Contact the Image Service Center
Please call us if you have any questions or problems getting your images. We're open Monday to Friday from 8:00 am to 6:00 pm. Use our interactive map to find us on our main campus in Boston. Our office is in room 0029 of the Blake Subbasement in the Blake Building.