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

Delivery Notes

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

Are you sure you want to delete this request? This will stop all work on fulfillment and a new request will have to be entered.

This is the method by which you would like to receive automatic notifications of the progress of your request(s), as well as how you will receive password updates from this website. If we have specific questions about your request, we will call you at the phone number listed.

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