EMB Medical Services

Because we are a HIPAA compliant organization, we require your written request to release all records. Please follow the link below to fill out the Immunization Record Request form.

https://www.dropbox.com/s/8oxw0q02f360dv9/Immunization%20Record%20Request.pdf?dl=0

Take a photo of the completed form on your telephone, and email to [email protected]. It will take 7 to 10 business days for your request to be filled.

If you went to Concorde Career College, IBMC or Re*****on College, there is a $25 fee. This must be paid by Paypal or money order, checks will not be accepted or returned. The request will be filled once we have received payment.

Please remit payment via one of the options below:
Money Order - Mail your money order, along with your Immunization Record Request form, to:

EMB Medical Services
6057 Nicklaus Loop
Keizer, OR 97303

Paypal - https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=8DFDCQWZ5FTNG

Immunization Record Request.pdf Shared with Dropbox