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☑ YES, I have medical records that proves my qualifying condition, or I can get them by my visit time.
I do not have medical records that prove my qualifying condition, and I would like you to help me get them.
If you do not have copies of your medical records and would find it difficult to go to your doctors office and pick them up before your visit, you can request them with this form. Please note, doctors offices can be slow to send records to other doctors offices, and this may delay your visit time. It is usually quicker to go to the office and get them yourself. However, if you can wait 1-3 weeks for your appointment, please fill this form and we will contact you as soon as we get the records. Medical Records