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Click ‘Get Form’ to open the Missouri Immunization Records application in the editor.
Begin by entering the child's name in the designated fields: First, Middle, and Last. If applicable, include any other names under which the record may be filed.
Fill in the Date of Birth by selecting the Month, Day, and Year from the dropdown menus provided.
Indicate the School or Childcare Facility that the child is associated with.
Complete the sections for Sex and Race by selecting from the available options.
Provide parental information by entering both Father's and Mother's names in their respective fields. Include Mother's Maiden name if applicable.
Sign your name in the signature field to validate your request.
Enter your address details including Street or P.O. Box, City, State, and Zip code.
Specify the purpose for which you need a copy of these records and your relationship to the person named on the certificate.
If you are a legal guardian or representative, ensure to provide necessary documentation as indicated on the form.
Start filling out your Missouri Immunization Records online for free today!
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If you do not have record of your vaccines, we can assist you in retrieving those records; A 15 minute wait after vaccinations is encouraged. Get emergency orRead more
Bureau of Immunizations Missouri Department of Health and Senior Services PO Box 570 930 Wildwood Dr Jefferson City, MO 65102-0570 Phone: 573-751-6124Read more
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