Forms

You can fill out our forms online or via PDF. Follow the links below to your choice. 

For PDF forms, you' can fill these out online via the links below, then download to your computer, and email the completed form to info@scandocimaging.com OR fax it to 714-424-9594.

DOCUMENT SCANNING ARCHIVING QUOTE REQUEST

• Fill out online

ATTORNEY REQUEST FOR RECORDS

• Fill out online

AUTHORIZATION FOR USE AND/OR DISCLOSURE OF MEDICAL INFORMATION (HIPPA COMPLIANT)

• General Release Form

• Kaiser Permanente

• LAC USC

• Little Company of Mary

• Providence Health Services

• UCLA Healthcare

• UCSD Healthcare

RECORDS REQUEST (NON-ATTORNEY)

• Fill out online

WCIRB REQUEST

• Fill out online