Grama Request Form FORM – English Required Contact Information Description of Record Sought Purpose Department Requested From I would like to view/inspect the record I would like to view/inspect the record I would like to receive copies of the record. I would like to receive copies of the record. I understand that the Health Department charges a fee for copies of records, and that copies will be provided subject to fees being paid. I further understand that the office will contact me and will not respond to a request for copies if I have not authorized adequate costs. Digital Signature By typing your name below, you are signing this form electronically. You agree to, and understand, all the information you are submitting: Click the SEND button only once. It will take just a moment to process your information. You will receive a confirmation email if your submission was successful.