FIRE/EMS RUN REPORT REQUEST | Corning Volunteer Fire Department

INCIDENT ADDRESS *

INCIDENT CITY/TOWN *

INCIDENT ZIP CODE *

INCIDENT DATE *

FIRST NAME *

LAST NAME *

EMAIL ADDRESS *

PHONE NUMBER *

REASON FOR REQUEST *

RELATION TO PARTY INVOLVED *

HOW WOULD YOU LIKE TO RECEIVE THIS REPORT *

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EMAIL

ADDITIONAL INFORMATION

DISCLAIMER IF YOU ARE REQUESTING A PATIENT CARE REPORT WE MUST HAVE THAT PATIENTS PERMISSION OR YOU ARE THE PATIENT YOURSELF !!

IF THE REPORT YOU ARE WANTING IS RELATED TO A DEATH ALL RECORDS WILL BE TURNED OVER TO THE CORONERS OFFICE !!!!!