The following items are available for download only for providers, due to budget. The only forms that we will be providing (limit to 50 forms per order) are the Official Record of Immunization (Yellow Form) and the WyVIP Vaccine Administration Form (Green Form). Please call 307-777-7952 to order these forms over the phone or fill out the form at the link below and fax to 307-777-3615 or mail to the Immunization Section at 6101 Yellowstone Rd., Ste. 420, Cheyenne, WY 82002
Material Request Form 03/23/11
We will no longer be providing the pocket-sized lifetime immunization records due to budget.
Please contact the Immunization Section if you have any problems downloading these materials. Thank you.
WyVIP Provider Forms
Vaccines Currently Available through WyVIP (VAC1) 6/16/10
Doses Administered Form (VAC2) 01/01/11
Vaccine Request Form 01/01/11
Special Clinic Order Form (VAC3) 6/16/10
Special Clinic Doses Administered Form (VAC4) 6/16/10
Flu Doses Administered and Inventory Form (VAC5) 9/16/10
Expired and Wasted Vaccine Return Form (VAC6) 01/01/11
Vaccine Transfer Form (VAC7) 01/01/11
Vaccine Temperature Log - Celcius (VAC9) 2/02/10
Vaccine Storage Troubleshooting Report 01/01/11
Current Inventory Form (VAC10) 01/01/11
Flu Special Clinic Order Form (VAC11) 9/16/10
Vaccine Transfer Request (VAC12) 2/02/10
Vaccine Arrival Report (VAC13) 6/16/10
Vaccine Information Statements (VIS)