To Place an order, you may:

• Simply fill out the form and submit
• Fax the order to 209-236-1774
• Need to speak to someone? Call 209-568-4714
• Email asapcopyservice@ymail.com
• Mail completed form to:

A.S.A.P Copy Service
211 McHenry Ave Ste B
Modesto, Ca 95354

 ASAP Request Form

OTHER AUTHORIZATIONS YOU MAY NEED:

EMANUEL MEDICAL AUTHORIZATION 

GENERAL HIPAA AUTHORIZATION

KAISER PERMANENTE AUTHORIZATION

MERCY MEDICAL DIGNITY HEALTH AUTHORIZATION

ST JOSEPHS MEDICAL AUTHORIZATION

SUTTER HEALTH AUTHORIZATION