COVID-19 Vaccination Record Card Request

Fill out the form below to request your COVID-19 Vaccination Record Card

This request form is only for patients that have already received their COVID-19 vaccine at an OHI.

(With the high volume of requests we are receiving for CDC cards the current processing time is 6-8 weeks.)

First Name*
Last Name*
Date of Birth*
Email*
Phone*
CAPTCHA