Records Collection & Analysis
Record Retrieval

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PLACE AN ORDER | ADD TO AN EXISTING ORDER | FAQs

Add to an existing order

We are always looking for ways to improve our on-line ordering process.
We would love to hear any suggestions you may have.
You may use this form to submit your order, or fax it to 713-460-6534.
Records Pertain to:
Patient's Name
Social Security No.
(000-00-0000)
Date of Birth


Attorney Of Record:
Additional Record Location(s):
Location 1
Name 
Address
Phone No.

Location 3
Name 
Address
Phone No.

Location 5
Name 
Address
Phone No.

Location 7
Name 
Address
Phone No.

Location 9
Name 
Address
Phone No.
Location 2
Name 
Address
Phone No.

Location 4
Name 
Address
Phone No.

Location 6
Name 
Address
Phone No.

Location 8
Name 
Address
Phone No.

Location 10
Name 
Address
Phone No.
Additional Information

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13105 Northwest Freeway Suite 300 | Houston, Texas 77040 | Phone: 713 460 9070 | Facsimile: 713 460 6519 | Toll Free: 800 264 9070
Info@marker-group.com