Patient Records Request Form

To request medical records, please download, complete, and submit the Emergicon Patient Records Request Form.

•    Fax the request (secure and direct) to 800-608-9457

•    Mail the request to PO Box 180446, Dallas, TX  75218

•    To email a request, we need to create a secure, encrypted email channel to receive your form. Please email with general information that you need to request records, and you will receive a secure email from us to use for the request process. Please do not send the completed request form using this email.

•    Call 972-602-2060 ext. 1611 if you need help. Se habla Español.

If you are an attorney, please submit your request via with the EMS service as the Provider.