Request IMMUNIZATION Health Records from Saint Mary's College

Thank you for your immunization health records request. Please note that this form is for IMMUNIZATIONS only. If you are looking for additional health records, please contact Women's Health via email ( or phone (574-284-4805). Saint Mary's College Women's Health maintains health records, as required by law, for seven (7) years. Due to the nature of PHI (protected health information) and as each situation is unique, please allow up to three days to receive your records. Please complete the information below.

Saint Mary's College treats your personal information with strict confidentiality.

Please note that * indicates a required field.

This tool helps prevent spam. Please provide the requested information before submitting the form.
7 + 9 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.