Health Connect America earns the trust and faith of our referral source with each assignment we fulfill.
To make a request for medical records, school notes and/or documentation please send an e-mail to the appropriate region.
Please select a location for the online form —or— you may download a print file and fax it to our local office.
|Alexandria, VA (PDF only)||Alexandria, VA|
|Abingdon, VA (PDF only)||Abingdon, VA|
|Bristol, VA||Bristol, VA|
|Big Stone Gap, VA (PDF only)||Big Stone Gap, VA|
|Charlottesville, VA (PDF only)||Charlottesville, VA|
|Culpeper, VA (PDF only)||Culpeper, VA|
|Harrisonburg, VA (PDF only)||Harrisonburg, VA|
|Leesburg, VA (PDF only)||Leesburg, VA|
|Lignum, VA (PDF only)||Lignum, VA|
Our network of direct care professionals, therapists, case managers and counselors cover every region and county in the state of Tennessee, the Decatur Alabama region, regions surrounding Atlanta, Georgia and many Virginia regions.
Health Connect America serves as a subcontractor for both private and public agencies, and accepts self pay, Medicaid as well as other third party payers.