Home
Forms Library
Immunization record form pdf

Printable Immunization Record Printable Immunization or Vaccination Record 2025

immunization record form pdf Preview on Page 1

See details

4.7 out of 5

55 votes

The document is an Immunization Record template designed to help individuals track their vaccinations. It includes sections for personal information, medical notes, and detailed entries for various vaccines, including type, date given, administered by, and next dose date. The document emphasizes the importance of keeping a copy for healthcare visits and provides a reference to the CDC website for additional vaccine information.

Here's how it works

01. Edit your immunization record form pdf online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send free printable immunization record forms via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Printable Immunization Record Printable Immunization or Vaccination Record with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Printable Immunization Record in the editor.
Begin by entering your last name, first name, and middle initial in the designated fields at the top of the form.
Fill in your birthdate using the format MM/DD/YY to ensure accurate record-keeping.
In the medical notes section, document any allergies or vaccine reactions that may be relevant for healthcare providers.
For each vaccination received, record the type of vaccine (e.g., HepB) and the date given in the appropriate columns. If you received combination vaccines, complete a row for each antigen.
Indicate who administered each vaccine by filling in the 'Administered By' field with details such as clinic or doctor’s name.
Lastly, note down any upcoming doses by filling in the 'Next Dose Date' column for future vaccinations.

Start using our platform today to easily fill out your Printable Immunization Record for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Is there a difference between immunization and vaccination?

Vaccination records (sometimes called immunization records) provide a history of all the vaccines you or your child received. This record may be required for certain jobs, travel abroad, or school registration.

Are shot records and immunization records the same?

A child is said to be fully immunized if child receives all due vaccine as per national immunization schedule within 1st year age of child. The two major milestones of UIP have been the elimination of polio in 2014 and maternal and neonatal tetanus elimination in 2015.