Your Health Information
Request Your Medical
Records
Need a copy of your records? Request them securely in minutes. Scan the code that applies to you.
Patient
Your own records
Patient Rep.
On behalf of a patient
Scan with your phone camera
Scan the QR code that applies to you and start a new request.
Verify your identity with a photo of yourself holding your government-issued photo ID.
Receive text or email updates. Records are typically ready in 5-10 business days.
Questions? Call (866) 992-7001
Medical Form Completion
FMLA, Disability & Other
Forms
For FMLA, Disability, Work Accommodation, and other forms, submitted and completed securely through Verisma.
How it works: Scan, accept the agreements, enter your info, upload your photo ID and the blank form, pre-pay the fee, and submit. Standard turn-around is 5-7 business days.
Per-Form Fees
Pre-payment required before processing. No form fees for Workers’ Compensation forms or patients with Medicaid coverage verification first.
Questions? allyforms@verisma.com