Request Medical Records
Patients and Physicians: Complete the form above and email firstname.lastname@example.org. Our medical records custodian will contact you when your records are prepared. We are happy to email you your records from our secure portal, or you can pick up a printed copy at our local clinic. When you receive the message from our secure portal you will click on the link and follow the simple instructions to access your documents.
Patients requesting the completion of FMLA paperwork or other forms should submit their request using our secure form. Our fee for form completion is $25.00. Completed forms will be released within 3-5 days of credit card payment.
Law Firms and Insurance Companies: Please submit your completed medical record request form through our secure form. We do not accept faxed requests. We do not accept checks as a form of payment for medical records. The only acceptable form of payment is by credit card.
Our fee for medical and billing records is $25.00. If you have forms that require a notary’s service, there will be a additional fee of $15.00. Medical records are released within 3-5 business days of credit card payment.