Seagrove, Inc. provides Advanced Records Retrieval, Court Reporting, and Litigation Support Services nationwide including digital images of medical records.

Fax Orders

For your convenience we have included the form below. Please print this page from your Web Browser, complete the appropriate fields and FAX to Seagrove, Inc. at 800.732.3312.

Date: ___________ Date Needed: __________	Ordered by: ____________________________
Attorney: _______________________________	Firm: _________________________________
Address: _______________________________	Phone: ________________________________
_______________________________________	Fax: __________________________________
_______________________________________	E-Mail: ________________________________
State Bar/Fed. I.D. Number: _______________	Representing: ___________________________

Case Information

Plaintiff:________________________________	Defendant: _____________________________
__________________________________	_________________________________
Cause No.: _____________________________	Court: ________________________________

Attorneys of record

Attorney: _______________________________	Firm: __________________________________
Address: _______________________________	Phone: ________________________________
_______________________________________	Fax: __________________________________

State Bar/Fed. I.D. No.: ___________________	Representing: ___________________________

Attorney: _______________________________	Firm: ________________________________
Address: _______________________________	Phone: ________________________________
_______________________________________	Fax: _________________________________
State Bar/Fed. I.D. No.: ___________________	Representing: __________________________

Types of Records Requesting:

____ Medical _____ Billing _____ X-rays	______ Admissible by Subpoena
____ Personnel _____ Payroll _____ Bank	______ Inadmissible by Subpoena
____ Academic _____ Police _____ Fire	______ Affidavit by Authorization

Other: _________________________________	Other: _________________________________

Records Pertain To:

_______________________________________	Date of Birth: ___________________________
a/k/a	Social Security No. ______________________
_______________________________________	Date of Accident: _______________________


Records Locations:

Name: _________________________________	Phone: _______________________________
Address: _______________________________	Date of Treatment: ______________________
_______________________________________	Note: Any and all records will be requested unless otherwise specified.

Name: _________________________________	Phone: _______________________________
Address: _______________________________	Date of Treatment: ______________________
_______________________________________	Note: Any and all records will be requested unless otherwise specified.

Name: _________________________________	Phone: _______________________________
Address: _______________________________	Date of Treatment: ______________________
_______________________________________	Note: Any and all records will be requested unless otherwise specified.

Advanced Record Retrieval