If you need to send us your medical records and/or your ID, please use this form to send us your records safely.
IF UPLOADING PHOTOS OF YOUR RECORDS, TAKE A PICTURE OF THE *ENTIRE* PAGE, NOT JUST EXCERPTS. PLEASE MAKE SURE YOUR RECORDS CONTAIN THE FOLLOWING ELEMENTS ON THE SAME PAGE WHEN POSSIBLE:
1. YOUR NAME
2. QUALIFYING DIAGNOSIS
3. DOCTOR'S NAME OR CLINIC/HOSPITAL NAME
4. DATE YOU WERE SEEN (IF POSSIBLE)
*Please note your documents will not be reviewed by our doctors, unless your balance owed is zero or paid in full.
Acceptable files are .PDF, .JPG, JPEG, .GIF
IF uploading multiple pages please combine them into 1-3 files if possible.