Immunization Resources

Use this form to order free immunization-related material from the Immunization Branch. Indicate the quantity of each item requested in the boxes below. For items that are available in packaged quantities, please indicate the number of packages you would like. If not marked, the materials are available on an individual basis.

Please bookmark this link for future materials order requests. 

Please allow 2-3 weeks for delivery. Thank you!

* 1. Contact Information for Shipping

Clinical Resources

* 2. Lifetime Immunization Record (DHHS 1065)
Available in packs of 100 

* 3. Vaccine Administration Record (DHHS 4041)
Available in packs of 250

* 4. Adult Vaccine Administration Record (DHHS 4057) 
Available in packs of 100

* 7. Vaccine Administration Log (VAL 122)
Available in packs of 25

Vaccine Ordering, Storage and Handling
Information for Parents

* 10. Reminder Postcards for Infants
Available in packs of 100

Resources for Schools

* 12. Kindergarten Postcard
Available in packs of 100

* 13. Kindergarten Flyer
Available in packs of 100

* 14. 7th Grade Postcard
Available in packs of 100

* 15. 7th Grade Flyer
Available in packs of 100

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