Please complete this form and fax it to:
605-342-7195 or e-mail it to info@expresscollections.com
Medical Records Release Form
* This agreement is not valid until signed by all parties. (Employee, Employer, and ECI Representative)
Please complete this form and fax it to:
605-342-7195 or e-mail it to info@expresscollections.com
* This agreement is not valid until signed by all parties. (Employee, Employer, and ECI Representative)