Fees and Services
Forms
Map & Directions
Contact Us

 



Forms

Our Immunization History and Authorization form is available to download in pdf format. In order to view this file, you need to have Adobe Acrobat Reader installed on your computer. If you do not already have it installed, you can download Acrobat Reader by clicking here.

CLICK HERE TO DOWNLOAD OUR
IMMUNIZATION HISTORY AND AUTHORIZATION FORM.


OPEN TO THE PUBLIC - By appointment only.
FEES - Payable by cash or credit card at the time of service.
HOURS OF SERVICE - Monday through Friday 9 AM to 12 PM and 1 PM to 3 PM

475 Riverside Drive at West 120th Street, New York City
Phone: 212-870-3053
Fax: 212-870-2401
Email: ticmo@interchurch-center.org