Filling Out a Medical Form

Medical Records

All your medical providers will need complete medical records.

This requires your signed consent to every facility releasing your records.

To Have Us Send Your Records

Download the PDF Medical Release of Information PDF form linked on this page.

Complete the form including the name and fax number of the provider or facility where you wish your records to be sent.

Fax the completed form to:  (801) 281-5960

Doctor and Patient

To Have Your Records Sent To Us

Create a list with name and fax number of every facility where you have received treatment. 

 

Fill out a separate Medical Release form for each facility and either fax to each facility or give the release forms to us and we will fax them for you.

 

If you have medical records in digital form in your possession, you can upload those records directly to us using the form below