Child Immunization Record Retrieval Request

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Complete this form to request that a copy of your child’s immunization record be sent to you by mail.  This service is only for residents of Ottawa, or for persons who have students attending a school in-person in Ottawa. Records for children 16 years of age or older must be requested by the child themselves.

You are eligible to receive your or your child’s immunization record if you meet the following criteria:

• You are the parent or legal guardian of a child under 16 years of age who lives or goes to school in Ottawa. OR
• You are the client requesting your own record, are 16 or 17 years of age and live or go to school in Ottawa.
• The information you provide in this form matches the information in the provincial database.
• Records exist in the provincial database.

**If you had previously met the above criteria but have since moved out of province, please continue and enter the last address you had in Ottawa.