1. Enter Request Information
  2. Upload Authorization
  3. Review and Submit

New Medical Records Request


Patient Information

Please select the visits/admissions you would like released:

Please select the type of information you would like released:
Medical Records


Purpose of Request

Please enter your reason for requesting records.

Your Information


Delivery Information

Normal processing time is 5 business days from time of receipt. Please contact us if you have any questions.


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