Immunization Records, Forms and Letters

Immunization Cards

  • Parents will be provided an immunization record card (California Yellow Immunization Record) for their child at the 2 month visit on request.
  • You may also request an immunization card during any check-up if you do not currently have one, but if there are a lot of immunizations that need to be entered on the card, we may need to mail it to you or ask you to pick it up in 2 business days.
  • This record should be kept and brought back to each visit the child is receiving immunizations in order to be updated. This is an important record as it will be needed for your child to enter kindergarten.
  • We will provide the first record free of charge and requests for replacement immunization record cards will be done for a $10 charge.  If you have lost your child’s immunization record, you will need to request a replacement and this will be ready to be picked up after 2 business days.

Preschool, School, Camp or Sports Forms

  • You may drop off or mail us preschool, school, camp or sports physical forms.  Please note that there is a $10 fee for filling out any forms that are dropped off.  Please drop off and pick up in the Main Office in Suite B105.  If you bring the forms to your child’s Well Visit or Sports/Camp Physical at the time of the visit, there is no fee.
  • In order for us to complete this, they must have had a physical exam within the last year if they are under 6 years; or within the last 2 years if they are over 6 years old.
  • Please attach a note to let us know if you want to pick up the form at our office or if you want to us to mail it to you or directly to the school or camp.  It is helpful if you attach an addressed envelope to ensure that it is mailed to the correct place.
  • Please allow 3 working days for these to be filled out.
  • Click on our Forms page to  download standardized forms for either school entry or daycare entry.

Letters

  • If you need a letter from your provider for sports clearance, school absence, medications to be given at school or camp, you may call to make a request.
  • Some schools or camps may have their own form that must be signed by the doctor to allow medications to be given.  If this is the case, please fill out as much as you know on the form including the name of the medication you are requesting be administered.
  • Let us know if you want your letter to be picked up, faxed or mailed and where to fax or mail the letter.