Request COVID-19 Vaccine Replacement Card

You are able to access your vaccination records online by visiting: https://dph.illinois.gov/vaxverify.html

If you are in need of a replacement for your physical COVID-19 vaccination card, please fill out the form below.

Name(Required)

First Last

Date of Birth(Required)

Phone(Required)

Email(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code

Reason for Request(Required)

Approximate date of vaccination(Required)

Preferred method of delivery:(Required)