Flu Shot Clinic Registration
 
 
 

The use of this page is for Hyde Park Pediatrics patients only.

 

This information is communicated to us via secure e-mail. If you use e-mail to communicate with one of us, you agree to the following:

1. Secure e-mail is not 100% secure.

2. E-mail should not be used for emergencies or time-sensitive issues.

3. If a response is not timely, you should call the office.

4. You should keep a copy of the e-mail you receive from us. 

5. We may keep a copy of the e-mail that we send you.

Please call us if you have any questions about these statements. Thanks.

Please Enter the Following Information

December 20th Saturday : 9:30am - 11:30am
January 17th Saturday : 9:30am - 11:30am
January 24th Saturday : 9:30am - 11:30am

Your Name:
E-mail address:
Phone Number
CHILDREN

1. Name:

D.O.B.

2. Name:

D.O.B.

3. Name:

D.O.B.

4. Name:

D.O.B.

5. Name:

D.O.B.

 

 

 

 
     
 

617.361.1470     fax 617.361.9060
695 Truman Pkwy, Hyde Park, MA 02136
100 Highland Ave, Milton, MA 02186
DIRECTIONS

All materials © Hyde Park Pediatrics
2003-2008
Contact Us

 
Home PCHI Harvard Medical School Directions Home