Obtain a Fire Incident Report form on this page and please turn it in person, via fax or mail. If the request is submitted via mail, please include a self-address and stamped envelope. Please call ahead to order the report, to ensure its availability and fee amount.
Incident Report Request Form
Obtain the Incident Report Request Form (PDF) and have it signed and notarized by the patient. If the request is submitted in person, please bring valid picture identification. If the request is submitted vial mail, please include a copy of the drivers license and a self-address stamped envelope.
Request & Authorization for Disclosure of Health Information Form
Obtain and fill out the Request and Authorization for Disclosure of Health Information Form (PDF). Please note we require the HIPAA form, completed, signed and NOTARIZED by the patient. As we need to have the original on file, the original document must be mailed or can be picked up at our office (with identification). Once received, report will be mailed and cover letter will include the cost for the report. We are unable to email or fax patient care reports.