Follow the steps to successfully complete your request for immunization records.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Indicate the preferred method for receiving the immunization record by selecting either Mail, Fax, or Email.
3. Fill in the requested immunization record information, including First Name, Middle Name, Maiden Name, Last Name, Date of Birth, and Gender.
4. Complete the requestor’s information section, including your Last Name, First Name, Relationship to the individual, Street Address, City, State, ZIP Code, Telephone Number, and Email Address.
5. Attach the required supporting documentation. Ensure you include a photocopy of your current state-issued driver’s license or picture I.D. If requesting for a minor, state your relationship to the child. If you are a social services agency, include a signed release of information form and court order.
6. Sign the form where indicated. A typed name will not be accepted as a signature.
7. Save your changes, download, print, or share the completed form according to your needs.

Complete your request for immunization records online today!