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

New Medical Records Request


Patient Medical Record Information



Requested Information

All medical records will be provided for a flat fee of $50.
NOTE: Billing records are not available. They should not be requested.
NOTE: Affidavits, Certifications, and Notarizations are not available. They should not be requested.


Designated Third Party Recipient



Third Party Contact Information


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