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Request for Access to Environmental Health Records

ALLEGAN COUNTY HEALTH DEPARTMENT
3255 - 122nd Ave., Suite 200, Allegan, MI 49010
Environmental Health Division
Phone: (269) 673-5415 / Fax: (269) 673-4172
Email:
AlleganEH@allegancounty.org
This is a request for permission to receive or examine the official Allegan County records related to the location indicated below.
***No access to medical records or records being used for current legal action.***

NOTICE: DAMAGING, REMOVING OR MUTILATING HEALTH DEPARTMENT RECORDS IS A VIOLATION OF LAW
1. Name of person making request:
2. Location requesting related records for:
3. Please indicateĀ what exact records are being requested (check all that apply):
4. Please specify how you would like to access the records requested: *This question is required.
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