Client Records Request

Project Community Connections, Inc. (PCCI) will be responsive to client requests for access to personal documents from agency records. Each individual adult will need to request their own records. Records are retained by PCCI for five years from the date of initial enrollment. Requests for documents will be provided within a 3 week period of time to allow for retrieving records from storage as needed.

Question Title

* 1. Date

Date

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* 2. Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 3. Documents requested

Question Title

* 4. Method of receipt

In person pickup

US Mail

Secure Email