Medical records

Request records through a verified secure form.

Use this page for medical records only. It is not for new symptoms, prescriptions, treatment questions, or urgent concerns.

Records request

Request records through a verified secure form.

Start by verifying your identity with an email code. After that, the records request stays inside this secure form instead of being sent through ordinary email.

Step 1

Verify your identity

Enter your full name, date of birth, and email. We will send a short verification code to that email before you can send the records request.

Full nameDate of birthEmail

Phone (optional)

This request is for your own records only. If you are a personal representative or authorized requester, please contact admin@quickvisitmd.com with authorization documentation.

Your records will be delivered through the secure patient portal. You will receive an access code by email when they are ready.

Request date

What records are you requesting?Typed signature

Release notice

I understand the practice may still need identity or authorization review before records are released.

Before you submit

Use this for medical records only.
Identity is verified first with an email code before the request is sent.
The records request stays inside the secure website form instead of ordinary email.

Administrative contact