Public Information Request Form

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Public Information Request Contact Form

The nature of your request*
Name*

First

Last
Email*

Enter Email

Confirm Email
Phone*
Address

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Comments

This field is for validation purposes and should be left unchanged.

Download and complete the form linked below, then email it to PublicInfoRequest@centralhealth.net.

Your request will be received by a member of Central Health’s compliance team and processed. A member of our team will contact you as soon as possible to follow up.

Download the FOIA Request Form

GET INVOLVED

Public Information Request Form

Complete the Form

Public Information Request Contact Form