Public Health Department Resource Order Form

Date: Organization:
Name: Address:
City: State:   Zip:
Phone: Fax:

Please order the exact quantities sufficient for a three-month period English Spanish
Record Cards Utah School Immunization Record (No longer availalbe. Printable
card link below - can be printed on any color paper.) English
Lifetime Personal Record (Yellow Card) English    
Schedule Cards Adolescent English | Spanish
Adult English | Spanish  
Childhood English | Spanish
Childhood 8.5 x 11 English | Spanish  
Other Materials Pertussis Tear Pads Surround your Baby double-sided
English/Spanish English | Spanish
Pertussis Tear Pads Surround your Loved Ones double-sided
English/Spanish English | Spanish
Pertussis Tear Pad Stands  
Perinatal Hepatitis B Lab Testing Form - 2010 version  
Plastic Sleeves  
Next Due Stickers (250 per pad)  
PPV Stickers (500 per roll)    
VFC Stickers (100 per roll)  
HPV Parent Tear Pad double-sided English/Spanish (50 per pad) English | Spanish  
International Certificate of Vaccination (ICV)    
Plastic Sleeves for ICV  
Posters Adult Immunization/You Never Outgrow Vaccinations 11 x 17
Adult Schedule Poster 11 x 17
Back to School Imm Requirements Poster 11 x 17  
Got Vaxed Poster Question Mark 14 x 20  
Got Vaxed Poster Teenagers 14 x 20  
Get the Flu Vaccine Poster 11 x 17  
Pertussis Surround your Baby 11 x 17  
Preteen Doctor Visit 12 x 20
Vaccinate Before you Graduate 11 x 17  
Brochures Get the Flu Vaccine English | Spanish
Got Vaxed Adolescent English | Spanish
Hepatitis A What You Should Know
Hepatitis B - Stop the spread
Older Adults Need Shots
Planning a Trip English | Spanish
Preteen Doctor Visit English | Spanish  
Protect Children by Protecting Yourself English | Spanish
Questions and Answers: A Guide for Parents about Childhood
Vaccinate Before you Graduate English | Spanish
Vaccine Safety
Please verify your order by entering the random letters (case sensitive) displayed in this image:

Contact Tammy Gresham with any questions (801) 538-9450. Include exact quantities sufficient for a three-month period. Due to limited inventory, your order may be adjusted.

Printable Utah School Immunization Record card here: Utah School Immunization Record