Immunization Record Request Form

  • Virginia Immunization Information System (VIIS)

    Immunization Record Request Form

    VIIS Record Request

    Request Immunization Record
    • Please provide complete information below to receive an immunization record. A VIIS representative will contact you within 24 to 48 hours to discuss your request.
    • IMMUNIZATION RECORD REQUEST FOR:

    • REQUESTOR'S INFORMATION:

    • This field is for validation purposes and should be left unchanged.