Immunization Record Request Form 2026

1. Click ‘Get Form’ to open the Immunization Record Request Form in our editor.
2. Begin by clearly printing your Last Name and Suffix, followed by your First Name and Full Middle Name. Ensure accuracy as this information is crucial for identification.
3. Enter your Date of Birth in the format Month/Day/Year. This helps verify your identity against the records.
4. Indicate your Gender by circling either Male or Female. This is a required field for processing your request.
5. Provide the Mother’s First Name and Maiden Name if applicable, as well as any counties in Georgia where immunizations were administered.
6. Fill out the Requestor’s Information section, including your name, relationship to the individual whose record you are requesting, current mailing address, contact phone number, email address, and fax number.
7. Remember to attach a clear photocopy of your current state-issued photo I.D. along with any supporting documentation required before submitting the form.
8. Finally, sign and date the form at the bottom to validate your request.

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