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Immunisation Records Request Form – Gold Coast Public Health Unit

Immunisation records can be accessed through www.my.gov.au.  If all records are unable to be accessed there this form can be used for additional vaccination information.

Please complete this form for each person that is a current or previous Gold Coast resident or Gold Coast student or employee and requires a record of vaccinations.

Records may take up to 3-5 working days to be collated and returned

Required fields are marked with an asterisk (*).

Have you/your child lived on the Gold Coast *
Are you currently or previously been a student or employee on the Gold Coast? *

Sorry we cannot provide your vaccination history. Please contact the Public Health Unit in the area where you live, study or work. Contact details for Public Health Units:
https://www.health.qld.gov.au/system-governance/contact-us/contact/public-health-units.

Client Details
Client's date of birth *
Requestor's details
Relation to client: *

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Privacy notice

Personal information collected by Gold Coast Public Health is handled in accordance with the Information Privacy Act 2009. Gold Coast Public Health is collecting information in relation to your personal details and immunisation record in order to assist us to provide you with accurate and up-to-date vaccination records.

All personal information will be securely stored and only accessible by staff members authorised to access your record. This type of personal information may be shared with your general practitioner or other vaccine service providers for the purpose of ensuring your vaccination records are accurate and those services providers concerned with your care are able to contact you in the event you may require further treatment or advice.  The Information Privacy Act 2009 sets limits on transferring personal information overseas and therefore if you are overseas we may not be able to send history via email.

Your personal information will not be disclosed to other third parties without consent, unless Gold Coast Public Health is required by law.

For information about how Gold Coast Public Health protects your personal information, or to learn about your right to access your own personal information, please see Queensland Health records and privacy information.

Last updated: 3 July 2018