You can fill out our forms online or via PDF. Follow the links below to your choice.
For PDF forms, download it to your computer, and then email the completed form to firstname.lastname@example.org OR fax it to 714-424-9594.
DOCUMENT SCANNING ARCHIVING QUOTE REQUEST
ATTORNEY REQUEST FOR RECORDS
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