Immunization Record Info Request

Who is the request for?

Enter Information

Please complete the fields below with your information. Make sure the information is entered exactly how it is documented at your health care provider. An exact match is required to obtain your immunization record. Please complete the fields below with your dependent's information. Make sure the information is entered exactly how it is documented at their health care provider. An exact match is required to obtain your dependent's immunization record.
All fields marked with * are required.

Verify Your Identity

Please enter your contact information below to verify your identity. Your information must be an exact match to what your health care provider has on file. As the legal guardian or parent of the dependent you entered above, please enter your contact information below to verify your identity. Your information must be an exact match to what your dependent's health care provider has on file.
Immunization records printed from this site may not be complete. The records represent only the data reported to and entered in the system.