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Iowa Department of Public Health Certificate of Immunization - Clover 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the applicant's last name, first name, and middle name in the designated fields.
- Fill in the date of birth for the applicant to ensure accurate record-keeping.
- Provide the parent or guardian's name, followed by their address and phone number for contact purposes.
- In the certification section, confirm that the applicant has received age-appropriate immunizations. Sign and date this section as required.
- Complete the vaccine history table by entering each vaccine received, along with the date given and the doctor or clinic source.
- Review all entries for accuracy before saving or exporting your completed form.
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