Release to Third-Party New Medical Records Request

Patient Information

Requested Information

Requested Records:

The following information will not be released unless specifically authorized by checking the relevant box(es) below:

Your Information

Delivery Information

Delivery options will appear here once you've selected the records you'd like to receive.

Delivery Summary

  • Normal processing time is 5-7 business days from time of receipt.
  • Please contact us if you have any questions.