Medical Records Release Form

Please print and complete the form below. Bring it with you to your next appointment at our office or fax it to 337-534-4492.

Download, Print or Fax 

Location

1211 Coolidge Blvd

Suite 401
Lafayette, LA 70503

337-541-1700

Phone

Fax

337-534-4992

Hours

MON    8AM - 5PM

TUES    8AM - 5PM

WED     8AM - 5PM

THURS 8AM - 5PM

 FRI       8AM -12PM

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