X
GO

Forms and Downloads

The Iowa Department of Public Health Immunization Program offers free print products to assist you in education of parents, providers, and general public on immunization issues.

Please complete the ordering amounts and shipping information on this page and products will be sent directly to you.

If you have questions about the products on this page please call the Immunization Program at 1-800-831-6293.

Order Form

Immunization Cards and Certificates

Certificate of Immunization (White 8½ X 11) Cardstock

This certificate is the official Certificate of Immunization required for children entering licensed child care and school.
Provisional Certificate of Immunization (White 8½ X 11) Paper

This certificate is the official Provisional Certificate of Immunization to be used when a child has begun but not completed the vaccines required for entry into licensed child care and/or school.
Medical Exemption (White 8½ X 11) Cardstock

This certificate is the official Certificate of Immunization Exemption for medical reasons for children entering licensed child care and/or school.
Religious Exemption (White 8½ X 11) Cardstock

This certificate is the official Certificate of Immunization Exemption for religious reasons for children entering licensed child care and/or school.
Standard immunization Parent Record (White 4 x 6)

This small card is designed for parents to record their child's immunizations for future reference. It is not an official Certificate of Immunization.
Master Index Card (White 8½ X 11)

This index card is designed for health care providers to maintain information regarding immunizations. It is not an official Certificate of Immunization.
Adult immunization Record (Ivory 6 3/8 X 3 3/8)

This small folded card will fit in a standard wallet and is designed for adults to record their immunizations for future reference. It is not an official Certificate of Immunization.

Pamphlets

HPV Brochure

This folded 3¾ x 8½ brochure outlines HPV, HPV vaccine information and recommendations. It is recommended for health care providers and general public use.
HPV Tips and Timesavers Factsheet

This 8 1/2 x 11 factsheet provides information and recommendations for talking to parents about HPV vaccine. It is recommended for health care providers.
Infant Immunization Pamphlet

This folded 3¾ x 8½ brochure outlines the recommended infant immunizations. It is recommended for general public use.
Adolescent Immunization Pamphlet

This folded 3¾ x 8½ brochure outlines the recommended adolescent immunizations. It is recommended for general public use.
Adult Immunization Pamphlet

This folded 3¾ x 8½ brochure outlines the recommended adult immunizations. It is recommended for general public use.
Influenza Immunization Pamphlet

This folded 3¾ x 8½ brochure outlines influenza immunization recommendations for all ages. It is recommended for general public use.
Iowa Immunization Law and You Pamphlet

This folded 3¾ x 8½ brochure outlines Iowa Immunization Law including the required immunizations for entry into licensed child care and/or school and the types of immunization certificates available in Iowa. It is recommended for general public use.
Hepatitis B Immunization Pamphlet

This folded 3¾ x 8½ brochure outlines the recommendations for hepatitis B vaccination for children. It is recommended for general public use.
HPV Brochure - Spanish

This folded 3¾ x 8½ brochure outlines HPV, HPV vaccine information and recommendations. It is recommended for health care providers and general public use.
Infant Immunization Pamphlet - Spanish

This folded 3¾ x 8½ brochure outlines the recommended infant immunizations. It is recommended for general public use.
Adolescent Immunization Pamphlet - Spanish

This folded 3¾ x 8½ brochure outlines the recommended adolescent immunizations. It is recommended for general public use.
Adult Immunization Pamphlet - Spanish

This folded 3¾ x 8½ brochure outlines the recommended adult immunizations. It is recommended for general public use.
Influenza Immunization Pamphlet - Spanish

This folded 3¾ x 8½ brochure outlines influenza immunization recommendations for all ages. It is recommended for general public use.
Iowa Immunization Law and You Pamphlet - Spanish

This folded 3¾ x 8½ brochure outlines Iowa Immunization Law including the required immunizations for entry into licensed child care and/or school and the types of immunization certificates available in Iowa. It is recommended for general public use.
Hepatitis B Immunization Pamphlet - Spanish

This folded 3¾ x 8½ brochure outlines the recommendations for hepatitis B vaccination for children. It is recommended for general public use.

Posters

HPV Poster 8.5 x 11
HPV Poster 8.5 x 11 Spanish
HPV Poster

This 11x17 poster features the "HPV Vaccine is the Key" campaign theme with infographics regarding HPV vaccination. The poster is recommended for health care providers and general public use. Room was left at the bottom of the poster for health care providers to add contact information.

Vaccines for Children

Patient Eligibility Public Provider - English

This 8½x11 form is used to screen children for eligibility in the VFC program. It is intended for use in a public clinic setting.
Patient Eligibility Public Provider - Spanish

This 8½x11 form is used to screen children for eligibility in the VFC program. It is intended for use in a public clinic setting.
Patient Eligibility Private Provider - English

This 8½x11 form is used to screen children for eligibility in the VFC program. It is intended for use in a private clinic setting.
Patient Eligibility Private Provider - Spanish

This 8½ 11 form is used to screen children for eligibility in the VFC program. It is intended for use in a private clinic setting.
Temperature Log Chart - Fahrenheit

This 8½x11 temperature log is designed to chart one month of refrigerator and/or freezer temperatures in Fahrenheit. It is designed for use for any setting that is storing vaccine.
Temperature Log Chart - Celsius

This 8½x11 temperature log is designed to chart one month of refrigerator and/or freezer temperatures in Celsius. It is designed for use for any setting that is storing vaccine.

IRIS

IRIS Reminder/Recall Postcards

This 8½x11 cardstock sheet has four perforated postcards on each sheet. It is designed to be used by clinics that are using IRIS to print out reminder/recall postcards for clients.

Vaccine Information Statements

Not Available

Vaccine Information Statements (VIS) are designed for use by facilities (public and private) administering vaccine. It is federal law that patients are provided a VIS and have the opportunity to ask questions regarding the vaccine to be administered. The VISs listed here are available for clinics in bulk. If single VISs are desired, please visit the CDC Web site to download the most current VIS.
 

Shipping Information

 (###) ###-####
  You may add a message or special shipping instructions. (500 characters maximum)