Request Patient Records

Submit a records request for an active or prior patient. Requests are processed in accordance with HIPAA and applicable state regulations. For security reasons, records delivered by email are sent under appropriate encryption protocols.

Requesting Attorney or Provider Name

Law Firm or Practice Name

Contact Email

Contact Phone

Contact Fax (if applicable)

Patient Full Name

Patient Date of Birth required

Authorization Status

Patient already has a signed Authorization to Release Medical Records on file.

I want to upload a Authorization to Release Medical Records with this request.

Upload Authorization to Release Medical Records (PDF)

Select File

Record(s) Requested (select all that apply) Required

Medical Records

Billing Statement (Ledger)

Itemized Invoices

Complete Patient File

Narrative Report (Subject to a separate preparation fee. The requestor will be notified prior to completion).

I confirm that I am authorized to request these records and that the requested information is permitted under applicable privacy regulations.

Your request has been received. Please allow standard processing time of 30 days for records delivery, although requests are often completed sooner when possible.