Immunization Record Request

FOR ALL REQUESTS, PLEASE ALLOW 48 HOURS (not including weekends & holidays). If records are needed ASAP, please fax a request to (602) 993-5788.

Immunization Record Request 2019-10-21T08:16:59+00:00


  • No records can be processed without a proper HIPAA#.

  • Tip: It is usually the last four digits of mom’s or dad’s Social Security number.

  • For your safety, do not put your entire SS#.

  • Please Note: Content Blockers may block proper functioning of this form, it is recommended that Content Blockers are turned off for optimal experience with this form.


Mon. – Fri.8:00 – 6:00*
Sat. – Sun.8:00 – 12:00*

*Note: Office hours are not fixed. If no patients are scheduled, the office will close.

Request Appointment

If your child requires a SICK or a SAME DAY APPOINTMENT OF ANY KIND do not use our form. Call the office for SICK or SAME DAY appointments: (602) 866-0550.