CONNECTICUT DEPARTMENT OF PUBLIC HEALTH
DPH Submissions System
No Login Required
Coronavirus (Covid-19) Case Report Submission
PPE Resource Request Form
COVID-19 Vaccine Clinic Pre-Registration
COVID-19 Vaccine Order (Enrolled CoVP Providers)
COVID-19 Vaccinator Submission
Connecticut Travel Advisory Complaint Form
EMS Education Approval System
Approved EMS Education
DPH Vans Intake Form
Incentive Partner Intake Form
Onboarding CT-WiZ Application
#Vax2SchoolCT | School COVID-19 Vaccine Clinic Plan Form (Ages 5-11)
Immunization Request Form
Respiratory Collection Supplies Request Form
Congregate Facilities & Senior Living Intake Form
Vaccine+ Utility Assistance Intake Form
FIRST TIME USERS:All first time users MUST register before you can login to the website.
Select the "Register as Submission User" link and create a new account.
DPH Employee Login
Register as Submission User
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