Request Help With Immunization Records 


  • 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.
(Required.)

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