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Records Request
All records requests are subject to fees ($150 or $25 plus 50 cents per page)
All records requests are processed in the order that they are received
Allow 7-14 business days for processing
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Client Last Name
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Client First Name
*
Your answer
Contact Information
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Your answer
Date(s) of Service
*
Your answer
Records Requested
*
Treatment Plan
Assessment
Other
Required
Email address where records are to be sent. ($150 Fee)
Your answer
Physical address where records are to be sent. ($150 or $25 plus 50 cents per page)
Your answer
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