Immunization Record Information Request Form
This form is intended for individuals that are having difficulty accessing their own or their children's immunization records through the myColorado mobile app or the Colorado Immunization Information System (CIIS) Public Portal.

Form responses are submitted to the Colorado Immunization Information System (CIIS) Help Desk. The CIIS Help Desk will follow up to your request via a secure email message sent to the email address you provide in this form.

Please only submit one form. Submitting multiple forms will result in an increased delay in receiving a response.
Sign in to Google to save your progress. Learn more
About the myColorado Mobile App (myVaccine Record)
Patients can use the myColorado app's myVaccine Record module to access their own COVID-19 vaccine record.

Note: At this time, the myColorado app only includes COVID-19 vaccination information.

Learn More about myColorado myVaccine Record: https://mycolorado.state.co.us/myvaccine-record
About the CIIS Public Portal
Patients and parents/guardians of minors under 18 can now use the Colorado Immunization Information System (CIIS) Public Portal to view and print an official record of their immunizations: https://vaccines.colorado.gov

Note: Immunization records from the CIIS Public Portal may not be complete. The records include what has been reported to and entered into CIIS.

How to Use the Public Portal to Retrieve Your Immunization Records: https://docs.google.com/document/d/1JQW82bCCB6PXcjs7FDMhwIwazCkCgKRwjfdw7q33ydc/edit
What is the purpose of your request? *
Required
If you are trying to use the myColorado app, which error message did you receive?
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of State.co.us Executive Branch. Report Abuse