Third Party Request Form

**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.

Please Read:

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

1. MedRecords provides copies that are released directly to an authorized requester to prevent any risk of tampering.

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

3. Please be aware that there is a $26.25 charge per request (GST included).

4. For medical legal requests, MedRecords can provide certified true copies for an additional $45 fee.