Request for Immunization Record from Public Health - Form

To access your vaccine records from Public Health, please use this form and follow the instructions to submit your request.

If you are a parent requesting information for your child, if your child has been determined to be a mature minor, then your child must sign the authorization form requesting their immunization records.

Please read the Patient to Provider Email Communications Fact Sheet and submit the Patient Communication by Emailing Consent Form along with your immunization request

Form: NSRIRPH