Patients & Requestors

Thank you for contacting DataFile Technologies. Please complete the form below and we’ll respond to your inquiry as soon as possible.

Have you submitted a request for a medical record to the appropriate provider?*
- Yes
- No
Tell us about you
Are you a patient or a third party requester?*
- Patient
- Third party requester
- Other
PLEASE SELECT ONLY ONE OPTION
Your Organization*
Your Name
Patient Name*
Your Email Address*
Enter Email Confirm Email
Your Phone Number
Tell us about your request
When did you submit your request?
MM
DD
YYYY

If you do not know the original date of your request, please leave this field blank.
Invoice number, if applicable:
If you do not have an invoice number, please leave this field blank.
Facility (Medical Practice) where care was provided:*
Where did you originally send the request?
What status question can we answer for you?*

Tell us about you