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Records Request Form

Fill out this form and click "Submit." All forms are processed and routed to the appropriate HG professional and should be replied to within 24 hours. If it is an emergency please call 1-888-656-DEPO(3376) or email info@hglitigation.com. * denotes a required field.

*DATE NEEDED:

TRIAL DATE:

DEPO DATE:

CAUSE NO.:

COURT:

COUNTY:

STYLE OF CASE:

*ORDERED BY:

*TELEPHONE NO.:

*EMAIL ADDRESS:

FACSIMILE NO.:

ATTORNEY FOR:	DEFENDANT PLAINTIFF

ORDERING ATTORNEY:

STATE BAR NO.:

LAW FIRM NAME:

LAW FIRM ADDRESS :

REPRESENTS:

RECORDS PERTAINING TO

LAST NAME:

FIRST :

MIDDLE:

DATE OF BIRTH:

SSN:

DATE OF DEATH:

INSTRUCTIONS

RECORDS OBTAINED BY:	AFFIDAVIT WITH AUTHORIZATION AFFIDAVIT THROUGH SUBPEONA WRITTEN QUESTIONS- ADMISSABLE WRITTEN QUESTIONS- INADMISSABLE

ALL COUNSEL OF RECORD

(COUNSEL 1)

ATTORNEY:

LAW FIRM NAME:

LAW FIRM ADDRESS:

REPRESENTS:

(COUNSEL 2)

ATTORNEY:

LAW FIRM NAME:

LAW FIRM ADDRESS:

REPRESENTS:

BILLING INFORMATION

SEND INVOICE TO:

ADDRESS:

CLAIM # / CLIENT MATTER #:

ADJUSTOR:

OTHER INSTRUCTIONS/ INFORMATION:

RECORD LOCATIONS (Out of state subpoenas may require special handling and/or fees)

PATIENT NAME:

LOCATION 1

PROVIDER:

ADDRESS:

TELEPHONE:

OTHER INFO:

LOCATION 2

PROVIDER:

ADDRESS:

TELEPHONE:

OTHER INFO:

LOCATION 3

PROVIDER:

ADDRESS:

TELEPHONE:

OTHER INFO:

LOCATION 4

PROVIDER:

ADDRESS:

TELEPHONE:

OTHER INFO:


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Schedule a Court Reporter

Request Info

Schedule a Meeting or Presentation

Order Video/Transcripts

Records Request Form

Training Registration