Denton Fire Department EMS Records Request

Denton Fire Department EMS Records Request

Patient Name*

Patient Date of Birth*

Date of Report*

Requestor Name*

Email Address to Receive Records*

Requestor Phone Number*

File Attachments*

Please fill out and upload the following: 1. EMS Consent to Release Records form from above. 2. A valid photo ID of recipient.

Drag and drop files here or

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