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1. Immunization Program Resource Guide Request Form 4.0

Patient Education Resources for Immunizations are available to all provider offices in Vermont. To order, you will need your 5-digit Immunization Program Provider Identification Number (PIN).
If you do not have a PIN, please contact the Immunization Program at (802) 863-7638 or by e-mail at immunizationprogram@state.vt.us

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* 1. Please enter the following information so we can mail your patient materials to you.

Requested By:

Practice Name:

Mailing Address:

Address 2:

City/Town:

State:

ZIP:

Email Address:

Phone Number:

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* 2. PIN #

Provider PIN number(5 digits)

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* 3. Please enter your fax number:

Fax Number:

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* 4. Date of Request:

Month/Day/Year

Date

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* 5. Vaccine Issues

Q&A The Facts About Childhood Vaccines

Ensuring the Safety of Vaccines in the U.S.

Understanding MMR Vaccine Safety

Are Vaccines Safe? Evaluating Information About Vaccines on the Internet

Q&A Vaccine Ingredients: What You Should Know

Q&A Vaccines and Autism: What You Should Know

Q&A Too Many Vaccines: What You Should Know

Clear Answers & Smart Advice About Your Baby's Shots

If You Choose Not to Vaccinate Your Child

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* 6. Pregnancy/Infants

Immunization and Pregnancy -- Specific Vaccine Recommendations

Immunization & Pregnancy -- Before, During, After

Pertussis Poster

Common Questions Parents Ask

Vaccines and Your Baby

Vermont's Simplified Childen's Immunization Schedule

Tips for a Less Stressful Shot Visit

How to Hold Your Child During Vaccination

Parent's Guide to Immunizations Required for Child Care

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* 7. Adolescents

Information for parents about pre-teen vaccines

Q&A For Parents of Pre-Teens and Teens About HPV Vaccine

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* 8. Adults

Adult Vaccination: 10 Reasons to be Vaccinated

Vaccinations for Adults: You are never too old to get immunized

Attention Older Adults Poster

Immunization Shingles Vaccine Poster

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* 9. Specific Vaccine Information

Chickenpox

Chickenpox Story

Flu

Measles

Measles Story

Whooping Cough (Pertussis)

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* 10. Any questions? Please call the Immunization Program at 1-800-464-4343 X7638. Any suggestions or feedback you'd like to give to the Program? Please use the text box below. Thanks very much!