Please complete this submission form for immunization record updates/requests to the Connecticut Department of Public Health. If you 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 an update to your record, or you are requesting an immunization record by mail or fax, please complete the form below and click Submit. Please allow 1-3 business days for processing your submission.
- Please complete the fields below with your (or your child’s) information, exactly how you reported it to your provider/clinic, as an exact match in the Connecticut Immunization Information System (CT WiZ) is required.
- * Note: A parent can only access an immunization record for their child under age 18. (A child under age 18 cannot access their own record.)
- If you have questions on how to complete this form, contact (860) 509-7929 during business hours Monday-Friday 8:30am-4:30pm.
- If you have other questions NOT related to immunization record updates/requests, please submit a helpdesk ticket.