Record Request Form

Information in individual requesting records

Name of Requestor (required)

Phone Number (required)

Fax Number

Email (required)

Street Address

Address Line 2

City

State

Zip Code

Information on records being requested

Date of Incident (required)

Address of Incident (required)

Patient Name if EMS (Authorization required. See below))

For medical records please include an "Authorization to Release Medical Records."

Please describe the records you are requesting and any additional information that will help us locate the record for you. (required)

Method of Delivery (required)

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

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Website Accessibility Policy

Riverside Fire Authority is fully committed to providing accessible facilities, elements and channels of communication to all members of the public. As part of this commitment, Riverside Fire Authority has a policy of providing an accessible website compatible with the Web Content Accessibility Guidelines (WCAG 2.1) and commercial screen reading software. All features of the website are coded to allow individuals with vision and other impairments to understand and use the website to the same degree as someone without disabilities. We welcome feedback and can often resolve issues in a timely manner if they arise.

If you need any special assistance or accommodations:

Call us at (360) 736-3975

Ongoing Compliance Information

Compliance Officer

Riverside Fire Authority has designated a compliance officer for website disability-related accommodations. The compliance officer has received training in website accessibility and updates the site in accordance with those best practices. Contact our accessibility officer to report an issue.

Compliance Procedures and Reports

In addition to testing with users with a wide range of disabilities and coding our website to WCAG standards, Riverside Fire Authority regularly scans its website to ensure ongoing compliance, and makes timely changes to any inaccessible changes, if any are found.

Linked Documents and Third Parties

Please note that this site may link out to third-party websites, such as state or federal agencies, that do not have accessible content. This site may also include documents provided by third parties included in our agenda packets, for example. While we cannot control the accessibility of content provided by third parties, we are happy to assist any member of the public with reading and accessing content on our site.

See an opportunity for us to improve? Please contact our accessibility officer or call us at (360) 736-3975.

Report a Website Accessibility Issue

We are committed to your ability to access all content, and we will respond to all requests as soon as possible.