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Immunization Record Upload
Patient's Name
*
First Name
Last Name
Patient's Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Immunization Record File Upload
*
Browse Files
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Choose a file
Please upload your copy of your child's immunization records so that the healthcare team may ensure their records are up to date prior to their visit.
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