Useful Documents

New Client Registration

Account Information

Firm name:

Address:

Phone & Fax:

Primary Contact (Account Administrator)

Name:

Email & Phone:

Users

Add all users who will access our portal and medical records.

Add additional user

Billing Contact

Copy Primary Contact

Name:

Email & Phone:

Order Information

$

Retention period

How long do you want us to retain the records in our electronic vault after completion of the request? (12-72 months)

Who does your firm usually represent?

What kind of case management software do you use:


Do you plan to change your case management software in the next 12 months?

Is your company using Google Workspace or Microsoft 365?

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Useful Documents

Letter of Representation

To retrieve your records, we require a signed Letter of Representation on your firm’s official letterhead. Below is a sample template for your convenience.

Download

“YIPAA” Form

This is our standard HIPAA authorization form, widely used by many of our clients. While you are welcome to use your own preferred forms, we provide this version as a reliable, time-tested option.

Download

HIPAA attestation form

A HIPAA attestation form is required by certain providers which is a statement of compliance that confirms a healthcare entity or business associate has met the requirements of HIPAA, particularly its privacy and security rules on reproductive health records.

Download