Medical Records RequestComplete the form fields below to generate a Medical Records Request that you can print and send to medical facilities to get medical records. (The current date is filled in automatically by the script creating the printable form.)
In order for the letter to be properly generated, all fields on this form must be completed. No information is gathered or used by us for any purpose whatsoever. It's just used to generate the printable letter.
Click here for a sample. All information appearing in bold type are the form fields that are either automatically completed by the program or completed based on information you supplied in this form.
This is not a substitute for legal advice and it is suggested that an attorney be consulted.