Pomona Pediatrics - Online Forms

Online Requests

Welcome to the online request area of the web site.   This section allows you to send us e-mail through the website to request a medication refill, a specialist referral, a copy of an immunization record, or a copy of medical records.  We will check our e-mail as soon as possible.  If you have an urgent request, please call the office.  Please note that because of a huge volume of spam, we do not accept any e-mail that has not been entered into one of the forms on this site.

Before using any of our e-mail functions, please understand that our e-mail system is not considered "secure".  Therefore any e-mails you send to us or that we send to you can theoretically be hacked.  If any of the information that we request on an e-mail form is private, and you would rather not take the risk, please just call our office.  By using any of our e-mail functions, you acknowledge that you have read this disclaimer and agree to the "risks".