Please fill out our Accident Record Request Form or fax your request to 813-514-1263 and one of our friendly accident care staff will assist you in you getting the records you need as soon as possible.

Accident Record Request Form
  • Patient First Name:*
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  • Patient Last Name*full name
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  • Company Name:*full name
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  • Contact Name:*full name
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  • Record Request:*full name
    4
  • Email:*a valid email address
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  • Phone:*full name
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  • Special Instructions:*something more
    7
  • Files*upload files hereUpload Release Form
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    • Captchacopy the words
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    • 10
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    Car Accident? Florida Law Requires You to Call!

    800-618-HESS (4377)