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Complete Electronic Form

We have electronic versions of our fax forms that can be completed by clicking on the ticket.

  1. Hit "Edit" on the top right of the form and answer the questions.
  2. Hit "Submit"
  3. After adding any additional documentation, hit "Notes Uploaded" on the right of the screen.


Fax Records

You can fax the records directly to us at 888-286-3058.

  1. Complete the questionnaire (If applicable, not all will have one) and or submit medical records (e.g. last office visit, labs, etc.).  

View file
nameSample Questionnaire.pdf
height250


Upload Records

You can upload documents through the online portal.

  1. Hit the paper clip to the right of the comment box.
  2. Select the file you wish to upload.
  3. After adding all information, hit "Notes Uploaded" on the right of the screen.