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Immunizations

Immunization Record Request
In order to process your immunization record request, we ask that you allow us 2 business days to prepare your record for mailing or pickup.  Fill out the form below to request immunization records for your child(ren).
Full Name of Parent(s) or Guardian(s)
Full Name(s) of Child(ren)


Reason for Request
Delivery
(allow 2 business days plus mail time)
Fax Number (if applicable)

©2007 Carl Pfanstiel, M.D. and Associates
1220 N. Elm Place
Broken Arrow, OK 74012
(918)258-1955
Fax: (918)251-9802

Site Developed in 2000 by Pfanstiel Enterprises