I give permission to contact the below named licensed prescriber to clarify information provided on the order should the need arise. Need a copy of your medical records Print complete our authorization form mail or fax it to the hospital or facility where you received service.CONTACT INFORMATION: Our administration office at 10777 Main Street in Fairfax is open during regular business hours 8 a.m. Form completion is usually 3-5 business days. We receive a large number of form request each week. Click on the link below to complete your request for medical records. You will be required to provide a valid email address and a government-issued ID. I understand that if I revoke this authorization I must do so in writing and present my written revocation to FPA's Medical Records Department. I, or my authorized representative, request that health information regarding my care and treatment be released as set forth on this form:. All businesses operating in the City of Fairfax must apply for an annual license with the Commissioner of the Revenue.