Montclair, CA · San Bernardino County
Request for Information Form
This form lets people request incident information or reports from the Montclair Fire Department by providing incident details and requester information.
What this form is
Use this form to request information about an incident, including a traffic collision, fire, EMS call, or other event. It asks for incident and patient details when applicable, the requester’s contact information, the type and reason for the request, and a signature. Incident reports cost $1 per report; third-party requests for medical records require written authorization compliant with HIPAA regulations.
Who needs it
People seeking Montclair Fire Department incident information or reports should complete the form with incident details and their own contact information.
How to submit it
Mail the request to Montclair Fire Department, P.O. Box 2308, Montclair, CA 91763. The form lists (909) 447-3540; incident reports are $1 per report.
About notarization
This form is signed without a notary; third-party medical-record requests require written authorization compliant with HIPAA regulations.
How to submit this form
- 1
Download The Form
Download the Request for Information Form to request information from the Montclair Fire Department.
- 2
Complete The Request
Provide the incident details, requester information, type and reason for the request, and sign and print your name.
- 3
Gather Written Authorization
For a third-party medical-record request, include written authorization compliant with HIPAA regulations.
- 4
Mail The Form
Mail the request to Montclair Fire Department, P.O. Box 2308, Montclair, CA 91763.
Frequently asked questions
- What information does the Request for Information Form ask for?
- It asks for the incident date, time, number and location; incident type; patient information if applicable; requester contact details; requested information and reason; and the requester’s signature.
- Do I need a notary for the Request for Information Form?
- No. This form is signed without a notary. Third-party requests for medical records require written authorization compliant with HIPAA regulations.
- How do I submit the Request for Information Form?
- Mail it to Montclair Fire Department, P.O. Box 2308, Montclair, CA 91763. The form lists (909) 447-3540, and states that incident reports are $1 per report.
Need something notarized?
This Request for Information Form doesn’t need a notary — but if you have another Montclair form that does, a commissioned online notary can help.