Get VFC Forms

Below is a list of the most commonly requested forms.  The following documents are listed in multiple formats. If you are unable to access the documents listed below or need a form that is not listed, please contact the Immunization Program for further assistance.

The following forms were just revised:  Vaccine Order Form, Vaccine Usage Worksheet and Vaccine On Hand Report. 

A new Flu Vaccine Order Form is now available.

Vaccine On Hand Report Vaccine On Hand Report	Vaccine Usage Worksheet Vaccine Usage Worksheet	Vaccine Order Form Vaccine Order Form  Flu Vaccine Order Form   Flu Vaccine Order Form
Vaccine Adverse Event Report	Vaccine Incident Report Vaccine Incident Report	VFC Patient Eligibility Screening VFC Patient Eligibility Screening

WVDHHR Immunization Program

350 Capitol Street Room 125

Charleston, West Virginia 25301-3715

(304) 558-2188  --   In West Virginia Toll Free 1-800-642-3634

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West Virginia Department of Health and Human Resources

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Last Updated: June 4, 2008