We’re excited to help with your medical record retrieval needs!
Step 1: Click here to download the Authorized Agent permission form. Please complete, sign, and save. You will be instructed to upload the document on the form below.
Step 2: Click here to download the Letter of Representation template. Please complete, sign, and save. You will be instructed to upload the document on the form below.
Step 3: To complete the onboarding process and establish portal access for all users, please complete the form below.
For questions, please contact [name] at [email address].
Please note: this form cannot be saved partway through, so please allow 10-15 minutes for completion.