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Request Help With Immunization Records 


  • If you or your child lost a CDC COVID-19 Vaccination Record Card, you can request a copy of the vaccination record by completing this form. You cannot get a replacement CDC COVID-19 Vaccination Record Card at this time, but you can get an official record that you have been vaccinated.

  • Please note your provider can review and add missing immunizations to your record.

  • CIR staff will review the information you submit and your request. You will be contacted if more information is needed.

  • If you are inquiring about records for more than one individual, please fill out a separate form for each individual.

Question Title

* Reason for request: (Select all that apply)

You will be able to describe your request in detail later.

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