Please fill out the form below and Dr. VanGundy will contact you to get scheduled! Name * First Name Last Name Child's Name * First Name Last Name Child's date of bith * MM DD YYYY Has your child received injectable Vitamin K? * Yes No How would you like to be contacted? * Text Email Email Phone (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Would you like the procedure done at home? There is an additional $100 fee for this * Yes No Thank you! Dr. Hughes will contact you soon!
