Records Collection & Analysis
Record Retrieval

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PLACE AN ORDER | ADD TO AN EXISTING ORDER | FAQs

Place an 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.
Style of case as you wish it to appear on legal papers
Cause No.
Court Case Filed In
County Case Filed In
Admissible Yes No
Inadmissible w/Affidavit Yes No
Affidavit of No Records Yes   No
Obtain By Authorization Yes No
Special Instructions
(Billing, Delivery, Claim No., etc.)


Ordered By:
Title
Direct Line
Email
Trial Date
Deposition Date
Date Ordered
Other
Attorney of Record
Firm
Address
City
State
Zip
Telephone Number
Facsimile
State Bar No.
Representing


List All Attorneys Of Record:
Attorney 1
Attorney 
Firm 
City 
Representing 

Attorney 3
Attorney 
Firm 
City 
Representing 

Attorney 5
Attorney 
Firm 
City 
Representing 

Attorney 7
Attorney 
Firm 
City 
Representing 

Attorney 9
Attorney 
Firm 
City 
Representing 
Attorney 2
Attorney 
Firm 
City 
Representing 

Attorney 4
Attorney 
Firm 
City 
Representing 

Attorney 6
Attorney 
Firm 
City 
Representing 

Attorney 8
Attorney 
Firm 
City 
Representing 

Attorney 10
Attorney 
Firm 
City 
Representing 


Records Pertain to: 
First
Middle
Last
A/K/A
Date of Accident
Date of Birth
Age
Social Security No.
(000-00-0000)
Date of Treatment and Other
Identifying Information
All Medical Records Yes No
All X-Rays Yes No
All Billing Records Yes   No
All Employment Records Yes No
All Payroll Records Yes No
Other
Specific Records as Follows


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.

 
For additional locations, press SEND above then click on
"Add to an Existing Order” form.
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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