For Physicians
Request Medical Records (Doctor's Office)
Use the form below to request medical records for your patient. We strive to respond within one business day. We can only send records to the fax number we have on file — if you need records sent to a different fax number, please call us at (877) 775-3377.
This form is hosted on Jotform's HIPAA-compliant servers. Do not include sensitive medical information unless specifically requested by the form.