Third Party Request (Legal and Insurance)

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Third Party Request

This form is for authorized Third Party Requestors only (Legal/Insurance). If you are requesting your own medical records, please refer to the Patient Request Form.

If you are a Third Party requesting a copy of a medical record, please request your copies below. Please note the following:

1. Provide Copies

MedRecords provides copies of FULL medical records directly to an authorized requestor and does not fulfill partial medical record requests.

2. Upload Letter

You will be required to upload a copy of the patient’s signed authorization letter or court ordered authorization letter.

3. Processing Fee

There is a non-refundable fee of $36.75 per request (GST included). Payment for the FULL medical record copy is required before shipping.

4. Certified Copies

For medical-legal purposes please request a certified true copy. All other requests will be watermarked and may not be admissible.

1Patient Info
2Organization Info
3Final Step