Immunization michigan 2025

1. Click ‘Get Form’ to open the immunization request form in the editor.
2. Begin by filling in your personal information. Clearly print your last name, first name, middle name, and maiden name if applicable. Enter your date of birth using the format Month/Day/Year.
3. Indicate your gender by selecting either Male or Female.
4. Next, provide the requestor’s information. Include your name and relationship to the individual for whom you are requesting the record. If you are a social services agency, ensure to include a formal request with necessary signatures.
5. Fill in your current address and indicate if you have moved recently. If applicable, provide both old and new addresses.
6. If your telephone number has changed, list both old and new numbers.
7. Finally, sign and date the form before submitting it as instructed.

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