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Request Your Medical
Records

Need a copy of your records? Request them securely in minutes. Click the link that applies to you.

Patient Submission
Patient Rep.
1

Click the link that applies to you and start a new request.

2

Verify your identity with a photo of yourself holding your government-issued photo ID.

3

Receive text or email updates. Records are typically ready in 5-10 business days.

Questions? Call (866) 992-7001

customerservice@verisma.com

Medical Form Completion

FMLA, Disability & Other
Forms

For FMLA, Disability, Work Accommodation, and other forms, submitted and completed securely through Verisma.

Visit to submit your form

How it works: Click, 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

Disability & FMLA Forms $80
Other Forms $35
Continuation / Updates $20

Pre-payment required before processing. No form fees for Workers’ Compensation forms or patients with Medicaid coverage verification first.

Questions? allyforms@verisma.com