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

New Medical Records Request


Patient Information

Please enter the date range for the visits/admissions you would like released:

Please select the type of information you would like released:
Medical Records
Itemized Billing for the dates of service I specified above

Your Information

Normal processing time is 48 hours from time of receipt of your order. 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.

There has been an error processing your request. Technical support has been alerted, however additional information will help solve this issue. Please send some brief comments describing what you were doing:

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