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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 call us at 1-888-365-5106 or email us at care@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