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Fairfax County, Virginia
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Fairfax-Falls Church Community Services Board

  1. Home
  2. Community Services Board
  3. About the CSB
  4. Requesting Your CSB Medical Record

Fairfax-Falls Church Community Services Board Alert:

CONTACT INFORMATION: Emergency - 703-573-5679 / Detox - 703-502-7000 (24/7)
703-383-8500 TTY 711
csbmedicalrecords@fairfaxcounty.gov
8221 Willow Oaks Corporate Drive
Fairfax, Virginia 22031
FairfaxCSB
Jordan A. Scheff
Executive Director

Department Resources

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    • Children, Youth & Families
    • Mental Health
    • Developmental Disabilities
    • Substance Use Disorder
    • Prevention & Wellness
    • Recovery & Peer Support
    • Suicide Prevention
    • Trainings
  • Accessing CSB Services
    • Get Help in an Emergency
    • Get Help When it's Not an Emergency
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    • Referrals to the CSB
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    • Online Payment Portal
    • Requesting Your Medical Record
    • Privacy Practices
  • CSB Board
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  • Your Rights & If You Have a Complaint

Related Resources

  • Human Services Resource Guide
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  • Diversion First
  • Northern VA Regional Projects Office
  • Va. Dept. of Behavioral Health & Developmental Services
  • Fairfax Prevention Coalition
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  • One Fairfax
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Requesting Your CSB Medical Record

If you have received or are currently receiving services with the Fairfax-Falls Church Community Services Board, you are entitled to access your records, and share information about your services as needed.

Records will be available to pick up or be mailed within 15 (fifteen) business days.

The CSB cannot release any information about people receiving services unless a signed Authorization to Disclose or Request Protected Health Information form is in place allowing that exchange of information.

There is also a Spanish language version of the authorization form (forma de Autorización para revelar o solicitar información de salud protegida) as well as guidance on completing the form.

Request your record online

Fill out and submit online the Authorization to Disclose or Request Protected Health Information form (Spanish language version also available). Once completed, the DocuSign program will automatically send the CSB your signed document.

Please remember to include a copy of your ID or we will be unable to process your request. There is a little paperclip on the online form that you may click on to attach documents.

  • Authorization to Disclose or Request Protected Health Information (in English)
  • Autorización para Revelar o Solicitar Información de Salud Protegida (en Español)
Complete the Authorization to Disclose or Request Protected Health Information Form

rows and columns of drawers containing catalog information

Request your record in person

Fill out a printable Authorization to Disclose or Request Protected Health Information form (Spanish language version also available) and bring to one of the following CSB locations:

  • Bulova Center 8221 Willow Oaks Corporate Drive, Fairfax 7 a.m. to 4:30 p.m.
  • Gartlan Center 8119 Holland Road, Alexandria 8 a.m. to 4:30 p.m.
  • Chantilly Center 14150 Parkeast Circle, Suite 200, Chantilly 8 a.m. to 4:30 p.m.
  • Northwest Center 1850 Cameron Glen Drive, Suite 600, Reston 8 a.m. to 4:30 p.m.
  • Pennino Building 12011 Government Center Parkway, Suite 300, Fairfax 8 a.m. to 4:30 p.m.

A records technician will review the form for completeness and adherence to federal, state and local regulations, and may ask for additional information.

To submit a request in person outside of the hours listed, please call 703-383-8480 to schedule an appointment.

Request your record via US mail

Fill out a printable Authorization to Disclose or Request Protected Health Information form (Spanish language version also available) and mail to:

Bulova Center
Attn: CSB Records
8221 Willow Oaks Corporate Drive
Fairfax VA 22031-4512

A records technician will reach out if additional information is needed.

Request your record via fax

Fill out a printable Authorization to Disclose or Request Protected Health Information form (Spanish language version also available) and fax to 703-653-6685. A records technician will reach out if additional information is needed.

Request your record via email

Fill out a printable Authorization to Disclose or Request Protected Health Information form (Spanish language version also available) and send as an attachment to CSBMedicalRecords@fairfaxcounty.gov. Please note that while this email address is as secure as any other Fairfax County email address, the information you send is not protected/confidential as it will not be encrypted. Also, this email address is for requests for records only.

At the time your records are released, a payment of $0.37 cents per page up to 50 (fifty) pages and $0.18 cents per page thereafter, or $6.00 for a CD, plus a $10.00 administrative fee will be collected to cover the costs associated with copying and researching your record.

If you have any questions regarding your CSB Medical Record, please call 703-383-8480.

Making a referral to the CSB

How to professionals/providers can make referrals to the CSB
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