Please choose one of the options below to submit a medical record, imaging or billing record request:
Online (Fastest way): Online requests are managed through Verisma. Submit your request here: https://vra.verisma.com/patient/
*To submit a request via mail, fax or email, please download the Authorization for Release of Patient Information form. Complete all required fields, sign, date, and return the form using one of the methods below:
Mail*:
WellMed
Health Information Management Department
909 Hidden Ridge Drive
Suite 300
Irving, TX 75038
Fax*: 817-514-7879
Attn: Health Information Management Department
Email*: recordrequests@wellmed.net
(If you choose to return the completed form via un-encrypted email, please note email is not a secure method of communication and carries some risk of being read by a third party.)
Online requests submitted through Verisma:
Requests sent via mail, fax or email:
No
Please have the doctor or clinic fax their request to 1-817-514-7879. Records will be sent directly to them.
Interested in learning more about WellMed? We are happy to help. Please contact our Patient Advocate team today.
Call: 1-888-781-WELL (9355)
Email: WebsiteContactUs@wellmed.net
Online: By completing the form to the right and submitting, you consent WellMed to contact you to provide the requested information.
Representatives are available Monday through Friday, 8 a.m. to 5 p.m. CST.
"*" indicates required fields