Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Record Request Form (Online)

  1. Department Logo (Cropped)

  2. Records Request Form

    COST: .50 cents per page(8.5 x 11) $5.00 flat rate for requests by insurance companies (not including photos) $10.00 CD Additional fees may apply.Contact Records for rates specific to your request. **Report will be destroyed if it is not picked up within 14 days of notification**

  3. INSTRUCTIONS

    This form must be completed accurately.Your signature affirms that the requested information will not be used for a commercial purpose and acknowledges that such a violation is punishable by a civil penalty -A.R.S 39-121.03

  4. CHECK ONE: I am the*

  5. Leave This Blank:

  6. This field is not part of the form submission.