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 (choose this to also pay by Debit/Credit Card) or send a check.
PAY WITH PAYPAL OR DEBIT/CREDIT CARD
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.