• Medical Pain and Spine Care of Indiana
  • 18077 River Road #200 Noblesville, IN 46062

For your privacy, please do not use this form for personal medical questions or medication refills. Instead, please use the secure patient portal or call the office at 317.776.7028 for further assistance.

Medical Records and forms
We have partnered with MediCopy for all medical record releases and disability or FMLA paperwork. MediCopy is HIPAA compliant and adheres to all state and federal regulations concerning release of medical information.

Copies of medical records are available at no cost if emailed or faxed to another provider; delivery fees apply if mailed. Please provide a fax number or email address on the authorization. Requests are completed within two (2) business days once received by MediCopy. To request medical records, please fill out an Authorization for Release of Medical Records online at medicopy.net.

Form completion is $30 for the first form and $15 for each additional form turned in at the same time. Once payment is received, forms are completed and sent to the requestor within three (3) business days.

Visit MediCopy.net
Call MediCopy at 866-587-6274
Email contact@medicopy.net
Text MediCopy at 423-397-4226 to begin a HIPAA compliant chat