Local Registrar Self-Assessment Survey

Fill out and print the form.

Local Registrar Self Assessment Survey Print

Mail the completed form, along with all required sample documents, to the following physical address:

Vital Statistics Unit
Attn: Field Services
Mailcode 1966
P.O. Box 149347
Austin, Texas 78714-9347

If you have questions, please contact your field representative or contact the Field Services team at fieldservices@dshs.texas.gov or (512) 776-3010.

 

 Field Services Representatives 

Field Representative

Region

Phone Number

E-Mail

 Gaetan Carpentier

5S & 6 

(512) 776-2598 

gaetan.carpentier@dshs.texas.gov

Derek Johnson

5S & 6

(512) 776-2530

derek.johnson@dshs.texas.gov

Mike McNutt

1, 9, & 10

(512) 776-2580

mike.mcnutt@dshs.texas.gov

Stephen McCandless

1, 9, & 10 

(512) 776-2611 

stephen.mccandless@dshs.texas.gov 

Juanita Moshier

4. 5N, & 7

(512) 776-2342

juanita.moshier@dshs.texas.gov 

Shannon Nagy

8 & 11

(512) 776-2501

shannon.nagy@dshs.texas.gov

 Anthony Patterson

2 & 3 

(512) 776-2503

anthonyv.patterson@dshs.texas.gov

 Danielle Smith

 8 & 11

 (512) 776-3651

danielle.smith2@dshs.texas.gov

Soo Teal

2 & 3

(512) 776-2534

soo.teal@dshs.texas.gov

 Raven Wrencher

 4, 5N, & 7

 (512) 776-6567

 raven.wrencher@dshs.texas.gov

  

Last updated July 24, 2017