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🏥 HIPAA-Compliant

Request Medical Records by Fax

Fill in the form — we generate a HIPAA authorization letter and fax it directly to the provider. For patients, attorneys, and authorized representatives.

✓ Instant fax delivery✓ Certified receipt✓ Tracks delivery status
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Step 1

Fill out the request

Enter your info, the patient info, and which records you need. We generate a compliant HIPAA authorization letter.

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Step 2

We fax it instantly

Your request is faxed directly to the provider's medical records department — no printing, no mailing.

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Step 3

Track delivery

Get a real-time fax delivery confirmation with a certified receipt you can save for your files.

Sign in to submit

Create a free account to submit requests, track fax delivery, and save drafts across sessions.

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You can fill in the form below — sign in before submitting.

Submission checklist

○Your name & relationship to patient
○Patient name & date of birth (MM/DD/YYYY)
○Provider name & fax number
○Record types & date range
✓Purpose of request
○HIPAA authorization acknowledged

1 of 6 checks complete

Medical Records Request

1. Who is making this request?

2. Your Information

3. Provider Holding the Records

4. Records Requested

5. Purpose of Request

6. Authorization

By checking the box below, you authorize the above provider to release the described medical records. This authorization is valid for one year from the date of submission and may be revoked in writing at any time. You understand that information disclosed may be re-disclosed by the recipient and may no longer be protected by HIPAA.
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1 of 6 checks complete — fill in required fields above

Who uses this

  • 🙋Patients requesting their own records
  • ⚖️Attorneys in personal injury or disability cases
  • 👨‍👩‍👧Parents or caregivers for dependents
  • 🏥Providers requesting records from other facilities

What you get

  • 📄HIPAA authorization letter — all required elements included
  • 📠Instant fax to provider records department
  • ✅Fax delivery confirmation & certified receipt
  • 🔒SHA-256 document hash for authenticity
Tip: Look up the provider's medical records fax number on their website under “Patient Services” or call the front desk. Most hospitals publish it publicly.

Learn more

Frequently Asked Questions

Is this HIPAA-compliant?

FaxSeal transmits your request via encrypted fax, which is a HIPAA-acceptable method for medical record requests. The authorization letter we generate includes all required HIPAA elements: patient identification, description of records, purpose, expiration, and your authorization statement.

How long does it take to receive my records?

FaxSeal delivers your request instantly — the provider typically has 30 days under HIPAA to respond, though state laws vary. Providers may mail, fax, or provide portal access to the records.

Can an attorney or representative submit on behalf of a patient?

Yes. Select your relationship to the patient during the form — attorney, authorized representative, or parent/guardian. The HIPAA authorization letter will reflect the correct relationship.

What if I don't know the provider's fax number?

Most hospitals and clinics publish their medical records fax number on their website under "Patient Services" or "Medical Records." You can also call the front desk to ask.

Do I need an account?

Yes — a free account is required so you can track fax delivery and access your confirmation receipt. Sign up in seconds.

Need to send records requests regularly?

Credit bundles give you the best rate — plus prior auth, legal notices, and more.

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