Reporting publicly funded vaccine provider concerns

If you have complaints related to vaccine provider violations of Senate Bill 23-260, Individual Access to Publicly Funded Vaccines, use this form. Only complaints related to this law can be reviewed and processed here.

Many health care providers in Colorado receive publicly funded vaccines. Those are vaccines provided to health care providers for free from the federal, state, and/or local government to people who are eligible. 

 A child is eligible to receive a publicly funded vaccine in Colorado if:

  • They are 18 years of age or younger and,
  • Enrolled in the Medicaid program, or
  • Have no health insurance, or
  • Are American Indian or Alaskan Native, or
  • Are seeking vaccination at a Federally Qualified Health Center (FQHC), Rural Health Center (RHC), or local public health agency (LPHA) and their health insurance does not include vaccine coverage or does not include specific vaccines.
Adults are eligible to receive public funded vaccines in Colorado if:
  • They are uninsured, or
  • They are seeking vaccination at a Federally Qualified Health Center (FQHC), Rural Health Center (RHC), or local public health agency (LPHA) and their health insurance does not include vaccine coverage or does not include specific vaccines.

 If you need a publicly funded vaccine for yourself or your child from a clinic that receives publicly funded vaccines at no cost, know your rights. The clinic may ask you for:

  • Health insurance.
  • A government-issued identification card.
  • A social security card or number.
  • An out-of-pocket fee for the administration of the publicly funded vaccine.

You do not have to provide any of these items to receive a publicly funded vaccine, even if the clinic asks for them. It is illegal for the clinic to deny you a publicly funded vaccine for not showing documents or paying a fee. This state law is found in section 25-4-2404 of the Colorado Revised Statues.

If you were denied a publicly funded vaccine for not showing documents or paying a fee, complete this form to tell the Colorado Department of Public Health and Environment (CDPHE) about it. CDPHE may follow up with you for additional information. If you are unable to complete this form and need assistance, email us at cdphe.dcdimmunization@state.co.us or call 303-692-2700. 


County where you had your vaccine appointment:
Name of clinic/provider:
Clinic/provider address:
Date vaccine was received or scheduled:
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Are you completing this form for yourself as an adult (19 years and older) or for your child (0-18 years of age) *
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