Fields marked with an * are required HTML To Request a Copy of a Youth EKGPlease complete this form first. Requests can take several weeks to process. EKG reports are only retained for one year. We do not retain copies or images of echocardiogram reports. Parent's First Name * Parent's Last Name * Email * Email Confirmation * Phone Youth's First Name * Youth's Last Name * Youth's Date of Birth * School Youth Was Screened * If you are a human seeing this field, please leave it empty.
