Request Immunisation Records

* Mandatory Field

Request for review of immunisation records in the Australian Immunisation Register

School Immunisation Records

For students enrolled in Year 8 during or prior to 2016.

Primary School Attended

High School Attended*

Please advise the years attended high school

Personal Details

Family Name*

First Name*

Date of Birth*

(dd/mm/yyyy)

Email Address*

Contact Phone Number*

Medicare Number*

Please Note:

The Berri Bamera Council Immunisation Team will endeavour to enter your school immunisation history in the AIR within 5 working days of receipt of the request.

If you wish to receive a copy of this request, please enter your email in the box below.

If you see this, leave this form field blank.

Email Submitted Data

Send a copy of the submitted form to this email address.

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