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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