* Denotes that the field is mandatory.

You can contact the Australian Immunisation Register (AIR) for:

• Obtaining infant immunisation records for children under the age of 14 years.
• To retrieve the records of immunisations given by doctors or any other providers.
• An immunisation history statement for anyone born on or after 1 January 1996.

Knox City Council maintains immunisation records for people who receive vaccinations through Knox City Council service. This includes immunisations given at primary or secondary school.

If you require a record quickly, you can access it at any time by using Australian Immunisation Register (AIR) self-help services:

• Medicare online account via the Medicare online account or via the myGov website
• Express Plus Medicare mobile app

These accounts/applications are linked to the Australian Immunisation Register (AIR) which can be contacted on 1800 653 809.

Please allow five (5) business days from receipt of request for retrieval of records.

Privacy Statement:
The personal information requested on this form is being collected by the Council for the purpose of accessing immunisation information. The personal information will be used solely for the primary purpose and will not be available to third parties.

Please provide the details for the individual you are applying for.

First Name *

Surname *

Please provide their Medicare Number.

Please provide their date of birth. *

Please list any changes that may have occured to Surname or First Name that will assist us with our search. *

Please provide your contact information;

First Name *

Surname *

Preferred method to receive record? *

Postal Address
Please populate to receive by post

E-mail Address
Please populate to receive by e-mail

Phone Number
Appropriate contact number if we need to contact you

Declaration:
I declare that I am the person nominated on this form or the parent/guardian of the child nominated on this form. *