Check your smoke detectors to make sure they work!

Close Icon
   
Contact Info     Call 24 Hours: 1.888.222.5847

EMS Report Request   arrow

Disclaimer
In order to receive an EMS report, the requestor MUST be present at 1800 West Main St (Station 3), Newark, Ohio at the time of receipt. The requestor must have a photo ID and sign for the copy of the report. If you are not the patient of can provide documentation that you are a legal representative of the patient, the you will receive a redacted copy of the report.
 I agree I do not agree

Name of requestor(required)

Address of requestor(required)

Requestor email (required)

Phone number of requestor (required)

Agency of requestor

Name of patient (required)

Date of occurrence (required)

Date you would like to pick up the report (required)

This request is in compliance with (state or federal law or regulation)

Any additional information

Please leave this field empty.

[mathcaptcha mathcaptcha-975]