If you are requesting a copy of your child's physical or immunizations please contact our pediatric department at 845-231-5577. Your pediatrician's assistant will pull this information for you.
 

Otherwise please click on "Immunization Record Request.doc" below to access the blank request form.

Fill it out completely and either mail it to 600 Westage Business Drive, Fishkill, NY 12524

or FAX it to 845-231-5647.

Make sure you completely fill out and sign the form and indicate where the immunization records are to be sent.

Request For Immunization Records Form