Make A Public Records Request

Make A Public Records Request

All information entered in the request form below will become a public record and may be included in subsequent record requests or posted in our records request log.
We may not be able to provide access to, or copies of, some records or information including but not limited to:
- Psychotherapy notes.
- Records or information that is no longer available.
- Records you are not entitled to receive under law, Oregon Administrative Rule, or Agency policy.
- Records not contained in the designated record set.
- If we deny all or a portion of your request, you have a right to request a review.
- You may be charged a fee for copying your records.
Name

Last NameFirst NameMI
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
List the type of record or information requested:
Date From:

MonthDayYear
Date
Date To:

MonthDayYear
Date
Select the preferred format to receive the record.

EmailMailPick up in personUSB flash drive
Fee Waiver

Request a fee waiver
For questions please contact:

Email: ltco.info@rights.oregon.gov

Fax: 503-373-0852

This document can be provided upon request in alternative formats for individuals with disabilities or in a language other than English for people with limited English skills.
Provide the email address where you wish correspondence related to this request to be delivered.
example@example.com
Should be Empty: