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Pay for Your Medical Records Request
Pay for Your Public Records Request
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Pay for Your Public Records Request
Pay for Your Public Records Request
Fields marked with an asterisk are required and must be completed prior to clicking Pay Now.
Records Request Type
*
Public Access Records
This form is for paying for Public Records requests. If you are paying for medical records, please use the
Medical Records Request Form
.
Invoice #
*
Invoice amount: $
*
First Name
*
Last Name
*
Email
*
A valid email address is required. Upon successful completion of your payment you will receive a receipt via email.
Phone Number
*
Please enter your phone number in case we need to contact you regarding this transaction or your records request.
Leave this field blank
Pay Now
