Please complete this submission form if you have tried to access your (or your child’s) immunization record through the CT WiZ public portal
and your record was not found, or you are requesting your immunization record by mail or fax and need to submit proof of identification to Connecticut DPH.
- When using the CT WiZ Public Portal to access your (or your child’s) vaccination record, the information entered must be an exact match with the CT immunization information system to be successful.
- Please complete the fields below with your (or your child’s) information, exactly as it should read in your (or your child’s) existing record in the Connecticut Statewide Immunization Information System (CT WiZ).
- * Note: A parent can only access an immunization record for their child under age 18.
- For any questions on how to complete the form, please contact (860) 509-7929 during business hours Monday-Friday 8:30am-4:30pm.