Retrieve Your Records

Order your records

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Review Service

Retrieval Service

Both

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Note: Please download the authorization form and fill out the required fields with your signature. Kindly make sure to attach the authorization form at the end of the submission process.

Fill your details

Please identify yourself

I'm a Patient/Claimant

I'm Attorney/Paralegal/Company/Law Firm

Your details

First Name

First Name is Required

Middle Name

Last Name

Last Name is Required

Email Address

Email Address is Required

Phone Number

Phone Number is Required

Address Line 1

Address Line 1 is Required

Address Line 2

State

State is Required

City

City is Required

Country

Zip Code

Zip Code is Required

Your details

First Name

First Name is Required

Middle Name

Last Name

Last Name is Required

Email Address

Email Address is Required

Phone Number

Phone Number is Required

Company/Firm Name

Company/Firm Name is Required

Job Role

Job Role is Required

Address Line 1

Address Line 1 is Required

Address Line 2

State

State is Required

City

City is Required

Country

Zip Code

Zip Code is Required

Your details

First Name

First Name is Required

Middle Name

Last Name

Last Name is Required

Email Address

Email Address is Required

Phone Number

Phone Number is Required

Date of Birth (MM-DD-YYYY)

Please enter a date in the format MM-DD-YYYY. Date of Birth is Required

Social Security Number(SSN)

Social Security Number(SSN) is Required

Address Line 1

Address Line 1 is Required

Address Line 2

State

State is Required

City

City is Required

Country

Zip Code

Zip Code is Required

Patient details

First Name

First Name is Required

Middle Name

Last Name

Last Name is Required

Email Address

Email Address is Required

Phone Number

Phone Number is Required

Date of Birth (MM-DD-YYYY)

Please enter a date in the format MM-DD-YYYY Date of Birth is Required

Social Security Number(SSN)

Social Security Number(SSN) is Required

Your details

First Name

First Name is Required

Middle Name

Last Name

Last Name is Required

Email Address

Email Address is Required

Phone Number

Phone Number is Required

Company/Firm Name

Company/Firm Name is Required

Job Role

Company/Firm Name is Required

Address Line 1

Address Line 1 is Required

Address Line 2

State

State is Required

City

City is Required

Country

Zip Code

Zip Code is Required

Case details

Case Name

Case Name is Required

Case Type

Case Type is Required

Case Sub Type

Case Overview

Case Overview is Required

Choose an option

Enter the provider details

Provider/Doctor details

First Name First Name is Required.

Last Name Last Name is Required.

Hospital/Provider Name Hospital/Provider Name is Required.

Phone Number Phone Number is Required.

Fax Number Fax Number is Required.

Address Address is Required.

Select the date range for record retrieval

Start Date (MM-DD-YYYY) Start Date is Required. Please enter a date in the format MM-DD-YYYY

End Date (MM-DD-YYYY) End Date is Required. Please enter a date in the format MM-DD-YYYY.

Choose the category of records for the retrieval

Select a category

Select the required services

Review Services

Medical Chronology

Narrative Summary

Deposition Summary

Demand Letter

Sorting & Indexing

Life Care Planning

Expert Medical Opinion

Medical Billing Summary

Special Reports (Optional)

Treatment Timeline

Missing Record Identification

Medical Synopsis

Pain & Suffering Chart

Med-A-Word

Future Cost Estimation

Special Injury Report

Strength & Weakness Report

Technical Services (Optional)

Indexing

Sorting

Duplicate Record Identification

Duplicate Record Extraction

Bookmarking

Other Patient Record Extraction

Hyperlinks

Other Language Translation

Please select the required service..

Do you need an estimate?

Yes

Choose atleast one option

Want to be expedited?

Yes

Expected delivery date (MM-DD-YYYY)

Please enter date in the format MM-DD-YYYY.

Review Services

Medical Chronology

Narrative Summary

Deposition Summary

Demand Letter

Sorting & Indexing

Life Care Planning

Expert Medical Opinion

Medical Billing Summary

Special Reports (Optional)

Treatment Timeline

Missing Record Identification

Medical Synopsis

Pain & Suffering Chart

Med-A-Word

Future Cost Estimation

Special Injury Report

Strength & Weakness Report

Technical Services (Optional)

Indexing

Sorting

Duplicate Record Identification

Duplicate Record Extraction

Bookmarking

Other Patient Record Extraction

Hyperlinks

Other Language Translation

Please select the required service..

Do you need an estimate?

Yes

Choose atleast one option

Retrieval Services

Aps Retrieval

Would you like to add any extra services to your order?

Sorting & Indexing

Duplicate Extraction

Additional Fees and Disclaimer

LezDo TechMed LLC applies $35 service charge per provider for record retrieval. Any additional fees, such as those for scanning, postal services, or related expenses, are to be covered by the client. The records will be released upon settling these charges.

The charges mentioned above are for the retrieval process only. An estimated amount for the review process will be sent separately once the retrieval process is completed, and we will start working on the review process after the estimated amount is paid.

I Understand

You must accept by clicking the checkbox.

Total Amount

$ .00

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