General Records Request Form

General Incident Request Form (non-EMS report request)

Requestor's Full Name (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Email (required)

Phone Number (required)

Reason for Request (required)

Can we send the report to the email address listed above? (required)

If no, what format would you like the document(s) in? (please include an address if requesting paper copies of the documents)

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

I agree to use electronic records and signatures

Date (required)

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