COVID-19 Vaccine Records

If you received your vaccine from Benzie-Leelanau District Health Department, your vaccine records have already been entered into the Michigan Care Immunization Registry (MCIR).

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* 1. What is your legal name?

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* 2. What is your Date of Birth

Date of Birth

Date

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* 3. What is your phone number?

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* 4. What is your mailing address?

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* 5. Copy of your COVID-19 vaccine card

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 6. Copy of your drivers license

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.