Medical Records Request

Please use the form below to request patient medical records. A secure encrypted electronic file will be emailed to you. If you have any questions, please contact us at 1-800-574-4792 x176 or email us at attorneymedicalrecords@mlrehab.com.

Please attach HIPAA release signed by your client (required)

Client Name

Attorney Name

Law Firm Name

Attorney Email (Where records will be sent)

Attorney Phone Number

Additional Information