Request a Copy of Your Child's EKG

 

If your child HAS ALREADY BEEN TESTED at a PREVIOUS EKG SCREENING by the Max Schewitz Foundation, you can order a digital copy of your child's EKG to be sent to you by email for a $10 handling fee.   (This form is NOT for upcoming screening registration.)  You may pay by PayPal or send a check.

 

Pay with PayPal

Complete the form below, once you click SUBMIT, a Paypal link will display to facilitate payment of the $10 handling fee.

Pay by Mail:

Complete the form below and send a copy of the form or a written request including Parent's Name and email, Child's Name, Child's Date of Birth, and age/year EKG was conducted along with a check for $10 to: Max Schewitz Foundation, 700 E. Park Avenue, Suite 105, Libertyville, IL 60048.  Requests by mail may take 3-4 weeks for delivery.

Please note: EKGs provided prior to the 2014/2015 school year were most likely completed on paper and have been shredded.