Authorization Forms

 

HIPAA Compliant Patient Authorization

 

VA Medical Authorization

 

Employment Payroll Authorization

 

Bankruptcy Trusts Authorization

 

Tax Return Authorization Form

 

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 #)

 

UCLA Authorization

 

Kaiser Permanente Authorization

 

* 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.

 

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