Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Immunization Records Request

  1. *COVID Vaccine* If you were vaccinated with Operation Safe or North Kansas City Hospital, a record of your vaccination can also be found in the myhealth patient portal. Learn more.

    To request a copy of an immunization record, please fill out the following information:

  2. How to Receive Record*
  3. Which records would you like?*
  4. Leave This Blank:

  5. This field is not part of the form submission.