Medical Record Upload
Email
Email is optional. If you do not add an email, you will not recieve a confirmation notice of receipt.
Please upload your document(s)
*
Browse Files
Drag and drop files here
Choose a file
You may upload up to 5 seperate documents. Total file size allowed is 10mb. Acceptable formats include: PDF, DOC, DOCX, JPG, JPEG, PNG, HEIC or AVIF.
Cancel
of
Please verify that you are human
*
Submit
Should be Empty: