*if Attorney Requestor Type is selected, request must originate from the requesting attorney office on letterhead
Note that any requests sent via US Postal may be delayed by 2 - 3 weeks. There is no fee for Secure Electronic Delivery (Follow My Health Account no fee)
Documents to Include:
Select a start and end date.
By submitting this request you acknowledge that payment is required prior to release of records. An invoice will be sent to the email or fax number provided above. Delivery times are from the date payment is received.