Instructions for Submitting Requests

ATTENTION 3RD PARTIES: The Options below are for patients only. If you are NOT a patient, please click here.

ALERT: This system lets you as a patient or parent/guardian request that medical records be directed to a designated third party. You will not be able to access those records yourself. Only the third party will be able to access them through a secure website. If you prefer to access the records yourself and then direct them to a third party in whatever way you wish, please click here to use the 48-hour Quick Release short form for Comprehensive Pain Specialists.

What You Need to Get Started

  1. The patient's valid driver's license or other valid state-issued ID.
  2. If you have the legal right to make healthcare decisions for a patient (custodial parent, legal guardian, healthcare trustee/conservator, healthcare proxy, medical/healthcare power of attorney), you may place the request on behalf of the patient. NOTE: A financial power of attorney is not acceptable. You must upload YOUR OWN Driver’s License/ID AND the Driver’s License/ID of the patient AND your official documentation of your ability to make healthcare decisions for the patient. If you cannot provide ALL of these items, the patient must place his or her own request.
  3. A credit card to make payment
  4. The name, address, and fax number of the third party to whom you are directing your records.

Please have these items handy before you start!

Important - Please Read!

NOTE: Third parties are not eligible to use this form to request records from Comprehensive Pain Specialists. Only patients or parents/guardians of patients are eligible to request records using this form.


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