The form below may be used to transmit medical and related records securely to our office.

  • Please enter your name (or the name of doctor or practice whom you represent).
  • Please enter your email address. You will receive an automatic confirmation message that the records were received.
  • The file(s) will be sent securely to our office.
    Drop files here or
    Accepted file types: pdf, doc, docx, odt, rtf, png, jpg, gif, xls, xlsx, Max. file size: 32 MB, Max. files: 5.
    • This field is for validation purposes and should be left unchanged.