Request Health & Medical Record - American Urgent Care

OPEN 5 DAYS A WEEK. WALK IN OR CALL

Request a Health Record from American Urgent Care & Infusion Centers

American Urgent Care & Infusion Centers Provides You or Your Primary Care Physician with a Copy of Your Medical Records.

The process is easy. Simply fill out the form below and we will get in touch with you shortly.

First Name

Email Address

Last Name

Patient's Date of Birth

Contact Cell Number

Patient's 5 Digit Zip Code

Last 4 Digits of SSN

Which Clinic Is It Related To

Message Subject

Enter Your Message

Contact Us

First name

Last name

Email Address

Phone

Message