Proof of Immunization

Complete the form to have your Proof of Immunization emailed to you. If you want to pick up the Proof of Immunization in person, please contact us at (205) 348-3033 or cchsflublast@ua.edu.

Name(Required)

First Last

Email(Required)

Date of Birth(Required)

Month and Date of Flu Shot if Known

Flu Shot Location

Transmission of Health Information Over Email(Required)

By checking this box you agree to have your Proof of Immunization sent over email which is potentially insecure.

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