Please complete this form and fax it to:
605-342-7195 or e-mail it to sales@expresscollections.com
Medical Records Release Form
![Doctor smiling doctor with gray hair with his arms folded over his chest](https://paymyaccount.net/wp-content/uploads/2020/05/doctor-e1589763263674.jpg)
* 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 sales@expresscollections.com
* This agreement is not valid until signed by all parties. (Employee, Employer, and ECI Representative)