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.
Note: For DPH to correct/update your record and to provide an immunization record to you, you must provide proof of identification as listed below. Below you will also be able to upload proof of corrections/updates.
Upload your valid photo identification (ID) of the Parent/Guardian.
Upload your valid photo identification (ID).
If you do not have valid photo identification (ID), you must upload/attach any two of the following documents and all documents must have the same name as listed above: