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Immunization Record Request

New York State law requires us to maintain medical records for six years from the date of last visit. Additionally, New York law requires that information contained in medical records be held in strict confidence and not be released without your written authorization. If you would like a copy of the immunization records you provided to Roberts Wesleyan University, please complete this authorization and request form. An uploaded copy of your photo identification is required to complete the request.

We appreciate your patience and understanding that your request may take up to 10 business days to process.

Immunization Form