DO NOT submit this form if you are able to find your record through the CIIS Public Portal. This form is intended to help correct any demographic errors in the Colorado Immunization Information System that is preventing you from retrieving your COVID-19 vaccination record through the Public Portal or myColorado App. 

Your Personal Information

Name

Contact Information

Contact
Address

Date and location of vaccination

Where did you receive your first dose (i.e. Pueblo Mall, State Fair, Safeway)?
Where did you receive your second dose (i.e. Pueblo Mall, State Fair, Safeway)?