Authorization Forms

 

HIPAA Compliant Patient Authorization

 

VA Medical Authorization

 

Employment Payroll Authorization

 

Centers for Medicare & Medicaid Services

 

Texas Medicaid Authorization

 

Bankruptcy Trusts Authorization

 

Tax Return Authorization Form
(*Note: Written Deposition Service, LLC will no longer submit these requests. The IRS rarely provides responsive records to third parties, yet they require substantial prepayments, which may or may not be refunded.)

 

Texas Department of Family and Protective Services

 

Military Records

 

Social Security Earnings

 

Texas Workforce Commission Authorization

 

Social Security Disability Records
(This governmental entity requires their specific authorization to be dated within 60 days)

 

* TWCC 153 Form
(This form is used when you have the Claim #)

 

* TWCC 155 Form
(This form is used when you do NOT have the Claim #)

 

* Note: This form is NOT a request to be fulfilled by Written Deposition Service, LLC.

You must request these records directly from the law firm. The TWCC does not accept third-party request.

 

UCLA Authorization

 

Kaiser Permanente Authorization

 

If you do not see your form listed, please contact us:

 

Toll Free: 800-346-4405
Local: 972-488-5555
Fax: 972-488-5590
E-mail:
Sheila.Lazzara@writtendeposition.com