Sign Up to Request Records Medical Records Release, ChartRequest

Step 1

Create account

Step 2

Add Address

Step 3

Verify Your Account

Step 4

Confirm your identity

× Account was successfully created
× Please check the reCAPTCHA box below.
× Password does not meet all the requirements. Please check your password.
Only letters & numbers allowed
Only letters & numbers allowed
Only letters & numbers allowed
Enter valid email Login email already exists You may not invite Users from that domain.
Email does not match

Password must meet all requirements:

  • Minimum 8 characters
  • At least one lowercase letter (a-z)
  • At least one capital letter (A-Z)
  • At least one number (0-9)
  • At least one symbol (!@#$%^&*)
Password does not match

To continue, type the characters you see in the picture.

Captcha

The picture contains 8 characters.

Characters:

Invitation Sent | Waiting for Verification

Your request has been sent for access to the account! Please contact your account administrator to expedite verification.

Go to ChartRequest

Organization Exists with ChartRequest

We've found multiple matches for

Please select your organization from the list below.

already has an account with ChartRequest. If the following information matches your Organization, click on "invite me!" to request an invitation to the account

Name
Address
Cancel

Please select an option

Select organization type
Select job function
Enter organization name
Enter organization address
Enter valid city
Enter valid state
Enter valid zip code
Enter Fax Number
Back

Provider Exists with ChartRequest

already has an account with ChartRequest. If the following information matches your organization, you can click "Invite Me!" to request an invitation to the account.


address


Not your provider organization? Click "Continue with sign-up" to resume entering your organization information.

Invitation Sent | Waiting for Verification

Your request has been sent for access to the account! Please contact your account administrator to expedite verification.

Go to ChartRequest
  
By providing your telephone number you authorize ChartRequest to contact you via text messaging for purposes relevant to your account or ChartRequest’s services, such as billing reminders, maintenance notifications, payment confirmations, etc. Your consent is not a condition of purchasing any of ChartRequest’s goods or services. Message and data rates may apply. You may opt out at any time by visiting your account and updating your preferences or replying STOP to any message received. View our T&C here.

Enter Valid Phone Number

By providing your telephone number you authorize ChartRequest to contact you via text messaging for purposes relevant to your account or ChartRequest’s services, such as billing reminders, maintenance notifications, payment confirmations, etc. Your consent is not a condition of purchasing any of ChartRequest’s goods or services. Message and data rates may apply. You may opt out at any time by visiting your account and updating your preferences or replying STOP to any message received. View our T&C here. Enter Valid Phone Number
Enter Valid Phone Number By providing your telephone number you authorize ChartRequest to contact you via text messaging for purposes relevant to your account or ChartRequest’s services, such as billing reminders, maintenance notifications, payment confirmations, etc. Your consent is not a condition of purchasing any of ChartRequest’s goods or services. Message and data rates may apply. You may opt out at any time by visiting your account and updating your preferences or replying STOP to any message received. View our T&C here.
Back

Request & Retrieve Health Records

ChartRequest is a centralized, HIPAA-compliant platform to exchange medical, billing, and imaging records between entities.

Secure Record Exchange Platform

Leverage our secure exchange platform to manage and audit with a high-level view of all record transactions.