Vermont Vaccine Record Requests
The Vermont Immunization Registry is a secure database of immunization records. Individuals may request a copy of their vaccine records. Guardians of minors may also make a request. Please note, this form is not intended for healthcare providers and other users of the Registry requiring access, please return to our website for more information.
Email
*
Confirmation Email
example@example.com
Have you done a request before?
*
Yes
No
Unsure
First name
*
Middle name
Optional
Last name
*
Other names used in the past
i.e. maiden name
Date of Birth
*
/
Month
/
Day
Year
Minors under the age of 18 must have this form filled by their legal guardian.
Photo Identification
*
Browse Files
Drag and drop files here
Choose a file
Use this section to submit a photo of your government-issued photo I.D., even if you only plan to use this form to request for a child. If you do not have identification, please contact us.
Cancel
of
How would you like to receive your records?
*
Encrypted email (preferred)
Post mail (please allow up to five business days)
Mailing address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Who do you need immunization records for?
*
Yourself
One or multiple children (option to include yourself)
Another adult who you are the legal medical guardian
Vaccines Requested
*
Entire record
Covid
Other
Back
Next
Requesting vaccine records for a minor
Please note if the child is 18 or older, they need to request records for themselves.
Parent/Guardian Vaccines Requested
*
Entire record
Covid
Other
Would you also like your own immunization records included?
*
Yes
No
How many children do you need immunization records for?
*
Child 1 Vaccines Requested
*
Entire record
Covid
Other
Child 1 First Name
*
Child 1 Last Name
*
Child 1 Date of Birth
*
/
Month
/
Day
Year
Date
Child 2 Vaccines Requested
*
Entire record
Covid
Other
Child 2 First Name
*
Child 2 Last Name
*
Child 2 Date of Birth
*
/
Month
/
Day
Year
Date
Child 3 Vaccines Requested
*
Entire record
Covid
Other
Child 3 First Name
*
Child 3 Last Name
*
Child 3 Date of Birth
*
/
Month
/
Day
Year
Date
Child 4 Vaccines Requested
*
Entire record
Covid
Other
Child 4 First Name
*
Child 4 Last Name
*
Child 4 Date of Birth
*
/
Month
/
Day
Year
Date
Child 5 Vaccines Requested
*
Entire record
Covid
Other
Child 5 First Name
*
Child 5 Last Name
*
Child 5 Date of Birth
*
/
Month
/
Day
Year
Date
Back
Next
Legal Medical Guardians of Adults
Legal medical guardians may request vaccine records. These include guardians of minors and adults with medical decision-making powers. Please note: licensed childcare providers and school nurses are not included here. They should visit the Immunization Registry page for direct access.
Patient Vaccines Requested
*
Entire record
Covid
Other
Documentation of Guardianship
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Patient's First Name
*
Patient's Last Name
*
Patient's Date of Birth
*
/
Month
/
Day
Year
Date
Back
Next
Thank you for your request
After you click submit, we will verify the identity of the patient(s) then do a search and respond with the record(s). Please note: some patients over the age of 30 may be missing vaccine records before 1995 in the system. The Immunization Registry went live in 2004, and some older records have not been entered.
Anything else you would like to add?
How to Navigate Encrypted Emails
(You cannot access encrypted emails on a smartphone)
Click the "read message" text in the encrypted email.
This will open a new tab in your browser, prompting you to log in to your email.
You will then receive a second email with a passcode, which you will use to access your file(s).
If you are not able to access your file(s), contact us and we can send you copies in the mail if you provide us with your mailing address.
Submit
Should be Empty: