Eye Disorders
414-321-7520
Request Medical Records
We are committed to protecting your privacy while making it easy to request your medical records. To ensure your request is processed correctly, please select the option below that best describes you.
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Select the Appropriate Request Form Below
Patient Request
​Use this form if you are requesting your own medical records.
Patient Representative Request
Use this form if you are requesting records on behalf of a patient. This includes parents or legal guardians of minors, individuals with medical power of attorney, personal representatives of an estate, or others who are legally authorized to obtain a patient's medical records.
Attorney Request
Use this form if you are an attorney, law firm, or legal representative requesting medical records for legal purposes.
Processing Requests
Requests are processed in the order they are received. Please allow 5-7 days for requests to be reviewed and fulfilled. Incomplete requests or requests missing required documentation may result in processing delays.
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If additional information is needed, our Medical Records team will contact you using the information provided on your request.
Questions?
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If you have questions about which form to use or need assistance with a records request, please contact verisma at 866-504-5155 or customerservice@verisma.com.