Immunization Record Request Form

In order to streamline support requests and better serve you, we utilize a support ticket system. Every support request is assigned a unique ticket number which you can use to track the progress and responses online. For your reference we provide complete archives and history of all your support requests. A valid email address is required to submit a request.

All immunization record requests must be accompanied by documents that identify the person requesting the immunization record. Examples of acceptable forms of identification are a state-issued photo driver's license with address, a state-issued photo identification card with address or a U.S. passport or passport card with photo. Please lighten the copy of the identification cards.

If the record requested is for a minor under 18 years of age, please state your relationship to the minor in the "Requestor's Relationship" field.

Immunization record requests will be processed within 5-7 business days.
*Due to an increase in immunization records requests, please anticipate delays.