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• Records Order Form

Date


   

 

Your telephone number

Area      Prefix     Number        Ext.
      -     

Cause Number
 		Secretary or Paralegal

County    


Firm  


Requesting Attorney   

 
Representing
 Bar Number

 

Style of Case   

 

Court File In

County File In

State File In

 

VS.


 

RECORDS DESIRED

Records Pertaining to    

Specific Dates (if applicable)    

SSN Date of Birth Date of Incident

   

   

 

CHECK ITEMS REQUESTED

 
            Any and All
  Payroll
            Bank Records
  Personnel
            Billing Records
   School Records
            Employment
  X-Ray Films
            Insurance Policies
  X-Ray Reports
            Medical Records
   

            Other (please specify)    

 

CHECK QUESTION FORM DESIRED

 
           Non-Admissible
   Prove-Up Admissible
           Affidavit
   Attorney Furnished

 

OPPOSING COUNSEL

Opposing Counsel - 1

 

Opposing Counsel - 2

Representing
   Representing
     

Opposing Counsel - 3

 

Opposing Counsel - 4

Representing
   Representing
     

List any additional attorneys


OBTAIN RECORDS FROM

Please furnish any helpful information such as address, telephone, account, authorization of release or patient number, date of service, etc.

 
1.
 		  2.
     
3.
 		  4.
     

List any additional deponents

 

If no records OBTAIN AFFIDAVIT OF NO RECORDS     Yes     No

 

E-mail Address  

       

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Brannon Rasberry and Associates Inc.  •  300 East Main, Suite 1024  •  El Paso, TX. 79901
Tel: (915) 533-1199  •  Fax: (915) 542-1661  •  Toll Free: 800-526-5913  •  E-Mail: rasberry@rasberry.com
Brannon Rasberry and Associates Inc.  •  Disclaimer  •  Updated: February 2, 2006

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