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Immunization request form 2026

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The document is an Immunization Record Request Form for the Massachusetts Immunization Information System (MIIS), which tracks immunizations for residents. It outlines the process for requesting an Immunization Certificate, including required documentation and verification steps. The MIIS ensures confidentiality of immunization records shared among healthcare providers, but notes that records may not be complete due to reporting limitations. The form must be submitted to the Massachusetts Department of Public Health.

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Click ‘Get Form’ to open the immunization request form in our editor.
Begin by filling out the 'Individual or Child Information' section. Enter the full name, date of birth, and mother's maiden name for identification purposes.
Provide the gender and phone number. Ensure that your street address, city, state, and ZIP code are accurately filled in.
If you are 18 years or older, sign and date the form. If you are a parent or guardian completing this on behalf of a minor, fill in your details in the designated section.
Include a photocopy of your driver’s license or state-issued ID with sensitive information shielded. Attach a self-addressed stamped envelope for returning your records.
Review all entries for accuracy before submitting. Once completed, return the form to the Massachusetts Department of Public Health as instructed.

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

Do they still give immunization booklets?

Vaccine Information Statements are information sheets produced by CDC that explain both the benefits and risks of a vaccine to vaccine recipients. In the case of recipients under 18, they are provided to a parent or legal guardian. Federal law requires that VISs be handed out before each dose of certain vaccinations.

Can I get a copy of my immunization records online on mychart?

Go to My Record Health Summary and select the Immunizations tab. You can see the immunizations youve received and the dates on which you received them. Click the immunization name to learn more. If your immunizations are not up to date, please docHub out to your clinic directly to have your information updated.

How do I request my immunization records?

How to Contact Your Jurisdictions IIS contact the IIS in your state or in the state where you or your child received their last shots to see if they have records. contact your immunization provider directly or your local or state immunization program through your states health department.

What counts as proof of immunization?

Photocopies of immunization records from a licensed healthcare provider or clinic, or from a California K-12 school uploaded to My Health Portal. All records must show the vaccine type, dose, and date of each shot.

How do I get my SC immunization certificate?

How do I locate my immunization record? Visit the SIMON public portal to get your shot records, or contact your local health department or immunization provider. For help accessing your record using the SIMON public portal, click here.

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How do I get a certificate of immunization in SC?

To Find and Download a Vaccination Record: Go to the SIMON portal. Enter the patients information. Choose your relationship: Are you the parent, guardian, or self? Enter an email address. Click Search. Enter your verification code to see the patients immunization record or school certificate. Download your record.

Immunization request form 2026

Here's how it works

How to use or fill out the immunization request form

Complete this form in 5 minutes or less

Got questions?

Do they still give immunization booklets?

Can I get a copy of my immunization records online on mychart?

How do I request my immunization records?

What counts as proof of immunization?

How do I get my SC immunization certificate?

Security and compliance

Complete this form in 5 minutes or less

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How do I get a certificate of immunization in SC?

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