Records Request Portal
Request Patient Records
Authorized requests for patient records and clinical documentation can be submitted below. This portal is for treating providers, attorneys of record, and properly authorized representatives.
What You’ll Need
Required information for records requests
Submitting complete information ensures faster processing and avoids delays.
Patient Information
- Full legal name
- Date of birth
- Date(s) of service
Requestor Information
- Your name and organization
- Contact information
- Relationship to patient
Authorization
- Signed HIPAA authorization
- Case or claim reference if applicable
- Specific records requested
Submit Your Request
Online records request form
Submit your request below. Incomplete requests or requests without proper authorization will require follow-up before processing.
Replace with your WPForms or Elementor form shortcode.
Recommended fields: patient name, DOB, dates of service, requestor name/org, requestor phone, requestor email, relationship to patient, specific records requested, HIPAA authorization upload, case reference number.
Recommended fields: patient name, DOB, dates of service, requestor name/org, requestor phone, requestor email, relationship to patient, specific records requested, HIPAA authorization upload, case reference number.
Need records urgently?
For time-sensitive litigation deadlines or mediation requests, call our office directly. Do not use the online form for urgent requests.