Public Records Request Form

If you are interested in making a public records request, please complete and submit this form.

Our Public Records Officer will contact you regarding the next steps.

Today's Date *

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First Name *

Middle Name (enter NMI if no middle name)

Last Name *

Email Address *

Phone *

Street Address *

City *

State *

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Please provide identification of the public record(s) adequate for the PRO to locate the records: *

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View the records at EvergreenHealth Monroe Get a copy of the records (copying fees will apply)

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