Iowa Department of Public Health Certificate of Immunization - Clover 2026

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

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