Records Request – Obtain a Copy of a Report

Obtain a Copy of an Incident Report, Patient Report, or Environmental Record

Please fill out the form below to submit a Records Request. Please note, certain types of records requests may require a court order, a release form, and/or proof of identity prior to the record being released.

All Records Requests require a $20.00 records search fee.

Type of Record

Incident ReportEMS Patient ReportEnvironmental RecordsOther

If you marked Other, please explain

First Name*

Last Name*

Company

Mailing Address*

City*

State*

Zip*

Phone*

Your Email*

Intended use

Incident Number (if applicable)

Incident Date/Time (if applicable)

Incident Location (if applicable)

Patient Name (if applicable)

For Environmental Records Requests - Address of Requested Location (if applicable)

Questions/Comments

Payment Method:

Patient - Photo ID
Patient’s Parent/Guardian - Photo ID and Original Birth Certificate or Notarized Custody Document
Legal Representation or Other Designee - Notarized Statement of Request to Release

Please mail checks to:

SFMD Regional Training Center

Attn: Records Request

3700 E. 16th Ave.

Apache Junction, AZ 85119

Make checks payable to Superstition Fire & Medical District

Please leave this field empty.