To request a vaccination record, school excuse, sports form, or scout form, please fill out the following form.

Your record will take 2 business days to prepare. Please note: some of our forms are available for immediate PDF download.

View forms available for immediate download

Guarantor (Parent Information)

First Name
Last Name
Relationship to Patient
Best number to reach you
Email Address
Delivery Preference Pick UpFax
Which form are you requesting?
If faxing, please provide fax number
Who is receiving the fax?
As parent/guardian I give permission to release the requested information. (Clicking this box is your electronic signature)
Any Comments?

Patient Information

Please add your children
Add Child

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