Request Your Medical Records Easily and Securely

Provide your Information

Enter your details, including your name, contact information, and any relevant identifiers (e.g., MRN if you know it) to ensure your request is processed correctly.

Add Facility Details

Provide the contact details of the healthcare facility you’re requesting your records from.

Include Third-Party Information (if needed):

If your records need to be sent to a third party, such as a doctor, lawyer, or another provider, you can add their information as well.

Sign Electronically

After completing the form, a HIPAA-compliant authorization document will be generated. During the signing process, you’ll have the option to select the specific types of information you’re requesting by checking the appropriate boxes and adding any optional notes in the provided fields.

You’ll also securely upload a copy of your valid ID through Adobe’s trusted e-signature platform to ensure your request is valid. The entire process is designed to protect your privacy and keep your information secure.

Download and Send

Once signed, download the document and send it to the healthcare facility via email, fax, or mail.