CT WiZ Immunization Updates

Information Change Request

Please complete this submission form for immunization record updates/requests to the Connecticut Department of Public Health. If you 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 an update to your record, or you are requesting an immunization record by mail or fax, please complete the form below and click Submit. Please allow 1-3 business days for processing your submission.

  • Please complete the fields below with your (or your child’s) information, exactly how you reported it to your provider/clinic, as an exact match in the Connecticut Immunization Information System (CT WiZ) is required.
  • Proof of identification:
    • Please provide one of the following documents to validate your request:
      • Government issued identification
      • Passport
    • Should a photographic identification be unavailable, any two of the following documents in the list down below may be substituted as proof of identification.
  • * Note: A parent can only access an immunization record for their child under age 18.
  • If you have questions on how to complete this form, contact (860) 509-7929 during business hours Monday-Friday 8:30am-4:30pm.
  • If you have other questions NOT related to immunization record updates/requests, please submit a helpdesk ticket.
All fields marked with * are required.
Is the request for you or on behalf of your child (under age 18)?
Is the Patient address the same as the Parent/Guardian?
Please specify which update(s) you need to submit (select all that apply)
Please provide details of your corrections/updates in the box below.
Proof of identification

Please provide one of the following documents to validate your request:

  • Government issued identification
  • Passport

Should a photographic identification be unavailable, any two of the following documents below may be substituted for it:

  • Birth certificate
  • Written verification of identity from your employer
  • Current automobile registration
  • Current copy of utility bill showing name and address
  • Current checking account deposit slip stating name and address
  • Current voter registration card

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