Submit Payment - Datalink ITS

Thank you for contacting Datalink ITS in California to request a copy of your medical records.

This secure form is for patients requesting their own medical records for personal use or continuing care purposes. You may fill in the secure form below to request a copy of your medical records from our client medical facilities. Once complete please allow 7-10 days for processing.

If you have any questions please contact Datalink at 888-997-7299 or by email at customerservice@datalinkits.com

Payment Submission

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Invoice Number*

Payment Amount*

Name*

First Last

Credit Card Number*

Expiration Date*

Security Code*

Billing Zip*

Email*

Phone