314.849.3320
South County Pediatrics
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Dr. Irma I. Ortiz Arroyo
Dr. Maria S. Baszis
Dr. Teresa Kurtz
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Request a copy of your child's vaccine record - Please fill out the information below and we will get to you in 1-2 business days.
**If you need sooner, please call the office at 314-849-3320, option 4.
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Your Name
*
First
Last
Phone Number
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Child's Name
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First
Last
Child's Date of Birth
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Your Relation to the Child
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Mother
Father
Guardian
Self
Other (please explain in comments)
How Can we get it to you?
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Fax (put fax number in comments)
Mail (put home address in comments)
I will pick it up at the office
Email (put email address in comments)
Comment - please put the correct fax number, address, or email address here to receive the vaccine record in a timely manner.
*
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