School / Camp / Daycare Note Request Form
Need a note for school, daycare or camp? Please fill out the note request form in its entirety, below! 

Please note the following: 

  • If the patient is under the age of 18, all requests must be submitted by the patient's parent or guardian.
  • At this time, we are only accepting request forms through our website. 
  • Please allow up to 7 business days for completion of forms. While we make every effort to accommodate all requests promptly, processing times may be extended during periods of high request volume. 
  • Documentation requests require that patients have been seen for follow up care within the previous 12 months. 
  • Because of its time consuming nature, there will be a $5 fee for each completion of the NYS Office of Children & Family Services Individual Allergy & Anaphylaxis Emergency Plan. This fee must be paid prior to completion of request. 
  • For basic school or camp notes (not including the above NYS Anaphylaxis Emergency plan), an annual note can be completed at no charge. Any additional revisions or reissued notes will incur a $5 fee, which must be paid prior to processing.