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Medical Records Payment Form

  1. Medical Records Payment Form

    Please use this form if you received an invoice regarding the release of medical records for former residents of Portage Manor

  2. Invoice
    Medical Records
  3. # of Requests
  4. Online Payment Fees:

    Online payments are processed by Forte. A fee of 2.55% or $1.50 (whichever is greater) will be assessed for all credit card payments. Electronic Checks are also accepted, and will be assessed a flat $1.25 for any payment under $50,000. The appropriate fee will be added to the total cost of your payment.

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