Order Records

Use the form below to place your order for records. Orders placed via this form will be produced via regular turnaround (8-10 business days). For rush service, please contact us directly via email or phone.

    Fields marked with a are required.
    Your Law Firm Information

    Contact Information

    Your Name:

    Your E-mail:

    Contact Phone#:

    Direct Questions Form

    Please choose the form of direct questions required.

    AdmissibleInadmissible with AffidavitAuthorization with Affidavit

    Case Information

    Style of the Case:

    Cause No.:


    County of:

    Depo/Trial Date:

    Attorneys of Record

    Please list all attorneys of record in this case.

    Attorney 1Who Represents:

    Attorney 2Who Represents:

    Attorney 3Who Represents:

    Attorney 4Who Represents:

    Attorney 5Who Represents:

    Attorney 6Who Represents:

    Attorney 7Who Represents:

    Attorney 8Who Represents:

    Attorney 9Who Represents:

    Attorney 10Who Represents:

    Your Records Order

    Please fill out who you would like to order records of.

    First Name:

    Middle Name:

    Last Name:

    Social Security Number:

    Date of Birth:

    Other Identifying Information:

    Type of Records Needed

    Please Indicate what type of records you are ordering.

    Medical RecordsBilling RecordsBilling Records (Proved Up)Radiological FilmsPersonnel RecordsPayroll RecordsPolice Records

    Other Records:

    Date of Records

    Any and All DatesThe Following Dates Only:

    Affidavit of No Records

    If no records are available, do you require an Affidavit of No Records?


    Records Locations

    Please list all locations that would have the records you are ordering.

    Location 1Location 2

    Location 3Location 4

    Location 5Location 6

    Location 7Location 8

    Location 9Location 10

    Insurance Billing

    Please indicate wheather we are to directly bill an insurance company.

    Bill Insurance Company? YesNo

    Insurance Company:


    Claim No.:

    Billing Instructions:

    Comments and Instructions

    Comments and/or Special Instructions:

    Attach Any Additional Documents

    If you would like to send us additional documents for your records order, please upload the files from your computer. Your attachments cannot total to over 5 MB (5 Megabytes). PDF format or DOC format preferred.

    Attach Notice:

    Attach Notice:

    Attach Notice:


    Please note that your records order is not officially placed with us until we contact you for confirmation. By filling out the form above, you understand that the records order is not guaranteed until it is confirmed by our records department, who will contact you at their soonest opportunity.

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