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 DPH, please complete this online form.
*Note: If you are the legal guardian you must submit proof of identification and proof of guardianship to access the record. You may submit this to DPH through the online form or by mail to CT DPH Immunization Program 410 Capitol Ave, MS #11 MUN Hartford, CT 06134 or fax (860) 707-1925.