Request Records

To request a copy of medical records please submit the following items:
1. The Patient Authorization Form - this must be signed.
2. The Acknowledgement of Receipt of Notice of Privacy Practices Form.
3. A check or money order in the amount of $15.00.
Send your request with the appropriate forms and a check or money order made payable to:

Florissant Valley Fire Protection District
661 St. Ferdinand
Florissant, MO 63031

For the necessary forms, click on the following links:
Patient Authorization Form
Acknowledgement of Receipt of Notice of Privacy
Billing information may be obtained from our billing agency, Mediclaims, Inc. at (800) 538-8278.