LegalStream Add-on Checkout - Hospital / ER Medical Record Retrieval

Call Us Now

[email protected]

NOTICE: please be aware that records and bills can only be retrieved without an affidavit at this time.

Requester Information

Requester's Full Name *

First Name *

Last Name *

Phone *

Email *

Email for your receipt *

Law Firm Name: *

Plaintiff Information

Plaintiff Name *

Regarding which client?

Plaintiff Email Address *

Plaintiff Phone Number *

Plaintiff Mailing Address *

Client's DOB: *

Client's DOI: *

Date of Injury

Brief Incident Details *

Facility Name *

Facility Address *

Plaintiff Identification Card

JPEG, JPG, PNG, PDF or SVG ( max 2 Files )

Treatment Dates

Treatment Start Date *

Treatment end date *

By checking this box, I consent to receive transactional messages related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, and account notifications among others. Message frequency may vary. Message & Data rates may apply.Reply HELP for help or STOP to opt-out. Additional provider fee may apply.

Powered by

COPYRIGHTS 2025 | LEGALSTREAM | TERMS & CONDITIONS

Phone:: +1 210-592-4221