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Immunization Records Request Form
Please allow up to 5 business days for your records requests to be processed.
All requests must be made by the individual whose records are being requested.
Records will be sent directly to the requestor's email.
Immunization records are held at the first BOR Institution attended.
(*) Required
*First Name:
*Last Name:
Name while attending USD (if different):
*Date of Birth:
mm/dd/yy
*E-mail Address:
USD ID#:
*Phone Number:
*Years you attended USD:
for example: 2004-2008
Comments or Other Instructions:
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Contact Information
Student Health Services
Sanford Vermillion Clinic
University of South Dakota
20 S. Plum St.
Vermillion
SD
57069
Work
Phone:
605-624-9111 appointments
Work
Phone2:
605-638-8279 Rachel Svartoien
Fax
:
605-624-6636
student.health@usd.edu
www.usd.edu/shs
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