Immunization Record Request

You can use this page to request your child's immunization record from Hales Pediatrics. This is not a way to communicate health information and questions with our doctors.

Name Email Retype Email Phone Number Patient's Full Name Patient's Date of Birth

How should we handle the completed form -- Select One -- Email to you Keep at office for pickup

I hereby attest that the above information is correct and that I am the patient’s parent or legal guardian.

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