TexNotary.com

                                                                    Brenda Stone, Notary Public

877-829-8395   BUS.                     979-739-2690 LOCAL BUS          979-575-8364 CELLULAR/PAGER

                                                        877-548-2536 FAX

                                                                          Agent@TexNotary.com

                                                                          www.TexNotary.com

To:  Custodian of Records

Re:  “Office Call” Notary Services

 

If you need a notary for notarizing medical record affidavits, please call me.

 

I will make arrangements to bill the firm who is requesting the documents.  In most cases the law firm is usually happy to pay my fee, and, if not,

you will not be charged if I perform the work before knowing they do not agree to pay.

 

Next time you get a subpoena for records, or a request to produce records, fax me this form, or have the information handy when you call me.

 

- - - - - - - - - - - - - - - - - - - - - - - - - -FAX TO 877-548-2536- - - - - - - - - - - - -- - - - - - - - - - - - -

 

Who is making this request? 

Doctor/Company Name

Contact Name

Phone Number

Best Time/Day to come:

 

 

 

 

 

 

 

Address

City

Zip

Medical Records Custodian Name

 

 

 

 

 

 

 

 

 

Who wants the records?

Company Name

Contact Name

Phone Number

File Number

 

 

 

 

 

Address

City

Zip

Comments?

 

 

 

 

 

 

 

Patient

Name

Other Info you think I need