Call for Appointment: 323.730.1920

Request for Medical Records

All requests for release of medical information must be made by FAX or US MAIL or IN-PERSON. For your protection, email requests cannot be honored at this time.

To obtain your medical records, complete the Authorization Form for Release of Health Information. This form is available on request at any T.H.E. Health Center or it can be downloaded from the website using the link at the bottom of this page.

  1. Please fill in all required information for processing of the Authorization Form.
  2. Please review the authorization where an individual check off is required. Make sure you have signed and dated the form for release of this information.
  3. Provide a copy of your current picture ID to verify your identity. Please note that requests that are not completed, signed, and dated will be returned by mail within 48 hours for completion.

When the form is completed, you can choose to deliver it in-person at Medical Records Department on the first floor of our Western location at 3834 S. Western Avenue, Los Angeles,CA 90062. Or if you prefer, you can choose to fax or mail your request to the Medical Records Department as follows:

T.H.E. Health and Wellness Centers
3834 S. Western Avenue
Los Angeles, CA 90062
Fax: (323) 373-2042
Tel: (323) 730-1920

Effective November 1, 2022: unless otherwise provided by law, the fee for medical records is $15.00 per chart request. This fee must be paid in full prior to records being released. Payment can be made by cash, check or credit card.