Requesting Medical Records

Your Privacy Comes First


A patient, or his/her legal representative, may inspect and/or obtain a copy of their medical records. Acadian Ambulance requires a completed and signed Consent to Release Health Information form before releasing any documents to anyone, including the patient.

To request medical records or pay for previously requested records, please read the instructions below.

How to request a copy of your medical records

Print and complete the Consent to Release Health Information form. If you have issues with the fillable form document, click here to download a printable version of the form.

The release form must be completed, dated and signed.

Email form to:

Mail form to:
Acadian Ambulance Service, Inc.
P.O. Box 98000
Lafayette, LA 70509
Attn: Medical Records Dept.

Fax form to:
Attn: Medical Records: Release of Information


In Person:
2916 N. University
Building G
Lafayette, LA 70507

Monday – Friday, 8:00 a.m. – 4:00 p.m. CST
Closed on holidays

Click below to pay for requested medical records.

NOTE: You must have a copy of the medical records pre-payment invoice in order to make a payment.

Medical Record Payments