Request Records

Request billing records in two steps.

Complete the form, then upload your signed authorization and photo ID through the secure link. We cannot begin a request until both steps are done. If anything is missing, we will email you a notice listing exactly what we still need.

Before you submit a request

This form is for billing and account records only. We do not hold clinical records, original claims, EOBs, or ERAs.
Do not include your Social Security number, and do not upload medical records or statements. We only need enough information to find the account.
Patients and personal representatives: you will upload a copy of a government-issued photo ID. We compare it to the information on the account before releasing anything.
Attorneys, insurers, and other third parties: you must upload a HIPAA authorization signed by the patient (download the form) or a subpoena or court order.
Records are mailed to the address on file with the practice unless you provide documentation of a change of address. This protects you from someone requesting your records in your name.
Expect a response within 30 days of a complete request. Copy fees: [FEE SCHEDULE, e.g., "$X flat fee for electronic copies; $X per page plus postage for paper copies"].
Prefer paper? Download the printable request form and mail or fax it.

Complete the request form

About 5 minutes. Secure form hosted in our HIPAA-covered Microsoft 365 environment.

The form asks who you are requesting as, the practice name, the patient's name and date of birth, the dates of service, what you need (itemized ledger, payment history, balance verification, appointment history, reconstructed CMS-1500 if available), whether to limit the request to a specific payer, injury, or case, and how to deliver the records.

If the form does not load, open it in a new window.

Upload your documents

Secure upload. Files go only to our records team.

Signed HIPAA authorization — download our form (PDF) or use your own
Government photo ID of the person signing
If requesting for someone else: proof of authority (power of attorney, letters testamentary, or guardianship order)

PDF, JPG, or PNG · up to 25 MB each

Open secure upload

Please do not email these documents. The upload link is encrypted and stores files in our HIPAA-covered environment. You may also fax them to 888-518-4948 with the patient's name on the cover sheet.

What happens next

We review every request for completeness within 5 business days and respond to complete requests within 30 days, as HIPAA requires. If we need more time, we will tell you why and when to expect a response. Releases are limited to the dates of service, payer, and condition stated on the authorization.

Questions: [email protected]
Fax: 888-518-4948

Fees for copies

Fees follow the state law and federal guidelines that apply to the practice whose records you are requesting. Patients requesting their own records are charged only the cost-based fee HIPAA allows. We will tell you the fee, if any, before records are released.