Form HD002207 "Vital Records Appointment Request Form" - Pennsylvania

What Is Form HD002207?

This is a legal form that was released by the Pennsylvania Department of Health - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2020;
  • The latest edition provided by the Pennsylvania Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form HD002207 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Health.

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Download Form HD002207 "Vital Records Appointment Request Form" - Pennsylvania

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HD002207 REV 11/20
VITAL RECORDS APPOINTMENT REQUEST FORM
APPOINTMENTS RESTRICTED TO PENNSYLVANIA RESIDENTS ONLY
TO APPLY IN PERSON OR PICK UP
A BIRTH OR DEATH CERTIFICATE FROM
A PENNSYLVANIA VITAL RECORDS BRANCH OFFICE
REQUESTOR’S INFORMATION
Name:
Phone:
Email:
SELECT A LOCATION
Check the location where you intend to pick up your order. Additional locations will be added to this list as those locations reopen.
Erie Vital Records Office—Email:
RA-DHDVRErie@pa.gov
or Fax: 814-871-4809
Harrisburg Vital Records Office—Email:
RA-DHDVRHarrisburg@pa.gov
or Fax: 717-787-7100
New Castle Vital Records Office—Email:
RA-DHDVRNewCastle@pa.gov
or Fax: 717-213-6817
Philadelphia Vital Records Office—Email:
RA-DHDVRPhilly@pa.gov
or Fax: 215-560-6027
Fax this cover sheet and an application to the fax number listed for the location where you will pick up the order. Applications are available for
download from
https://www.health.pa.gov/topics/certificates/Pages/Forms.aspx
SERVICES REQUESTED
I am requesting the following service(s). Check ALL that apply.
Pick up a birth certificate or death certificate. My application(s) is attached.
Complete the paperwork onsite. I do not have the ability to complete it digitally and submit it to you prior to the appointment.
ACKNOWLEDGMENT OF REQUIREMENTS TO RECEIVE IN-PERSON SERVICE:
By submitting this form to the Vital Records Office, I am acknowledging that the following parameters apply when picking up my order:
I will be contacted to set up an appointment to pick up my order. I prefer to be contacted as follows:
By phone
By email
I would like to pick up my order within:
1 business day
3 business days
1 week
Other
I must pick up my own order and may not have someone else pick it up for me.
I will appear in person with no more than one other adult accompanying me to my appointment.
I and anyone traveling with me will wear a mask while in the Pa. Department of Health’s facility.
Due to a medical issue, I am unable to wear a mask. Please contact me to arrange for an accommodation.
I will pay for my order by credit card, check or money order during my appointment.
I will provide acceptable forms of identification (as outlined on the application) during my appointment.
HD002207 REV 11/20
VITAL RECORDS APPOINTMENT REQUEST FORM
APPOINTMENTS RESTRICTED TO PENNSYLVANIA RESIDENTS ONLY
TO APPLY IN PERSON OR PICK UP
A BIRTH OR DEATH CERTIFICATE FROM
A PENNSYLVANIA VITAL RECORDS BRANCH OFFICE
REQUESTOR’S INFORMATION
Name:
Phone:
Email:
SELECT A LOCATION
Check the location where you intend to pick up your order. Additional locations will be added to this list as those locations reopen.
Erie Vital Records Office—Email:
RA-DHDVRErie@pa.gov
or Fax: 814-871-4809
Harrisburg Vital Records Office—Email:
RA-DHDVRHarrisburg@pa.gov
or Fax: 717-787-7100
New Castle Vital Records Office—Email:
RA-DHDVRNewCastle@pa.gov
or Fax: 717-213-6817
Philadelphia Vital Records Office—Email:
RA-DHDVRPhilly@pa.gov
or Fax: 215-560-6027
Fax this cover sheet and an application to the fax number listed for the location where you will pick up the order. Applications are available for
download from
https://www.health.pa.gov/topics/certificates/Pages/Forms.aspx
SERVICES REQUESTED
I am requesting the following service(s). Check ALL that apply.
Pick up a birth certificate or death certificate. My application(s) is attached.
Complete the paperwork onsite. I do not have the ability to complete it digitally and submit it to you prior to the appointment.
ACKNOWLEDGMENT OF REQUIREMENTS TO RECEIVE IN-PERSON SERVICE:
By submitting this form to the Vital Records Office, I am acknowledging that the following parameters apply when picking up my order:
I will be contacted to set up an appointment to pick up my order. I prefer to be contacted as follows:
By phone
By email
I would like to pick up my order within:
1 business day
3 business days
1 week
Other
I must pick up my own order and may not have someone else pick it up for me.
I will appear in person with no more than one other adult accompanying me to my appointment.
I and anyone traveling with me will wear a mask while in the Pa. Department of Health’s facility.
Due to a medical issue, I am unable to wear a mask. Please contact me to arrange for an accommodation.
I will pay for my order by credit card, check or money order during my appointment.
I will provide acceptable forms of identification (as outlined on the application) during my appointment.