Adhs immunization record request form 2026

1. Click ‘Get Form’ to open the adhs immunization record request form in the editor.
2. Begin by filling out the 'Immunization Record Requested For' section. Enter the first name, middle name, last name, date of birth (month, day, year), and gender of the individual whose records you are requesting.
3. Next, provide your current address and phone number in the 'Requestor’s Information' section. Ensure that all details are accurate for effective communication.
4. In the 'Requestor's Relationship' field, specify your relationship to the minor if applicable. This is crucial for processing requests for individuals under 18 years of age.
5. Authorize the release of information by signing in the designated area. Include your printed name and date to validate your request.
6. Once completed, print and sign the form. Send it along with any required identification documents via email, fax, or mail as specified at the bottom of the form.

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