School / Camp / Daycare Note Request Form
Please fill out the note request form listed below. Due to the high volume of requests our office receives, completion of this request can take up to 14 days to be completed.

PLEASE NOTE IF YOU HAVE NOT BEEN SEEN FOR A FOLLOWUP IN THE PAST 12 MONTHS, A NOTE WILL NOT BE PROVIDED. PLEASE CONTACT THE OFFICE TO SETUP AN APPOINTMENT (315)701-9500.

All requests MUST be submitted by the patient's Parent or Guardian.