If you’re new to Connecticut or previously opted out of CT WiZ, you can enroll yourself or your child (under age 18) online, by mail, or by fax:
Complete this secure online form
Provide your contact information and select “Other/Unsure.” In the “Please provide details” box, type that you want to enroll in CT WiZ and include the following information for the person you are enrolling (yourself or your child under age 18):
- First and last name
- Date of birth
- Address (street address, city, state, zip code)
- Phone number
- Name and town of the doctor for the person you are enrolling.
Attach a photo, scan, or other image of your proof of identification and click submit.
Or enroll by mail or fax
You can print and complete the English CT WiZ enrollment form or the Spanish CT WiZ enrollment form. Or you can write a letter that includes the following information for the person you are enrolling (yourself or your child under age 18):
- First and last name
- Date of birth
- Address (street address, city, state, zip code)
- Phone number
- Name and town of the doctor for the person you are enrolling
- Also include a copy of your proof of identity.
Send your letter and a copy of your proof of identity to:
Mail:
CT Department of Public Health
Immunization Program
410 Capitol Avenue, MS# 11 MUN
Hartford, CT 06134.
Or Fax:
(860) 707-1925
Please do NOT try to enroll by email. Use only the secure options shown above to send us information.
Our staff will enroll you or your child in CT WiZ as soon as possible. Then you can view, download, or print your immunization record. Visit CT Wiz: Access My Immunization Record to learn how to view your vaccination record online or request a copy.