Records Request Form

If you are requesting any medical records, you will need to fill out the form below and upload it with your request.

SFD Medical Release Form 01-01-2024.pdf

First Name (required)

Last Name (required)

Company/Agency Name

Phone Number (required)

Email Address (required)

Mailing Address (required)

Preferred method of delivery (required)

Purpose of Request (required)

Type of record requested (required)

If you are requesting a fire report or medical chart, are you the patient or property owner?

If you are not the patient or property owner, please list your relationship to the patient or property owner.

Date of Incident or Meeting (required)

Location of Incident or Meeting (required)

Medical Information Release

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Your resquest will be responded to within five days.

Your request may be subject to a records request fee. This fee is based on cost recovery and will be invoiced at the time of the records being distributed.

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