Health Condition Validation Letter

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Request a Condition Validation Letter

If you are required to bring proof of a pre-existing condition to your COVID-19 vaccination appointment, please request a letter here. We will reply in your patient portal account, with a letter including conditions that are documented in your medical chart. If you do not have access to the portal, we will contact you with an invitation to the portal and/or make arrangements to get the letter to you by another method.

3Questions

1
Enter Your Full Name:* This field is required.
First Name
Last Name
2
Your Date of Birth:* This field is required.Be sure to use the format MM/DD/YYYY.
3
Your Date of BirthYou may type in the date, or use the date picker.
Date
Month
Day
Year
4
Tell us your vaccine appointment details:* This field is required.
I do not have a vaccine appointment yet.
Should be Empty:

Question Label

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