Record Services 

SERVING THE LEGAL AND CORPORATE COMMUNITIES FOR OVER 57 YEARS


EXPERIENCE • QUALITY • DEPENDABILITY

IL 312.726.6650  •  MI 734.591.4100  •  PA 215.241.5858

FORMS - ILLINOIS

Our request forms are available in three formats:
Acrobat® (PDF) - Word® (DOC) - Wordperfect® (WPD).

After selecting a form you can choose:
"Open" to load the form and fill it out or
"Save" to download the file to your computer.

PDF DOC WPD  Multi Record Request
PDF DOC WPD  Multi Record Request with Deponent Rider
PDF DOC WPD  HIPAA Authorization
PDF DOC WPD  HIPAA Authorization - with notary
PDF

DOC

WPD  Request For Copying/Printing
PDF DOC WPD  Help Note

AUTHORIZATION FORMS (PDF Format)

Academic Records
Employment Records

Advocate Hospitals
Advocate Lutheran General Hospital
Alexian Brothers Behavioral Health
Blue Cross Illinois 
Chicago EMS Ambulance Charges
Chicago Fire Dept EMS 
IL Dept of Children and Family Services (ICFS)
IL Dept of Corrections - Mental Health/Substance
IL Dept of Corrections - Medical Health
IL Dept of Healthcare and Family Svcs (Public Aid)
IL Dept of Human Services (IDHS)
IL Dept of Revenue - IL 4506
IRS - Form 4506
Mayo Clinic
Medicare
Military HIPAA

National Personnel Record Center (NPRC)
Social Security Administration (SSA)
Veterans Affairs
Walgreens

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