• Before You Begin
  • Complete Agency Form
  • Enter Payment Info
  • Review & Submit
  • Confirmation

About this form

Please use this form to pay for all request of copies of medical records

Accepted Payment Methods:

  • Bank account (ACH)
  • Amazon account
  • PayPal account
  • Debit or credit card

This is a secure service provided by United States Department of the Treasury. The information you will enter will remain private. Please review our privacy policy for more information.

Contact:
Tracy L. Murry
Phone:
(915) 742-6199