Public Health Department Resource Order Form

Date: Organization:
Name: Address:
City: State:   Zip:
Phone: Fax:

Please order the exact quantities sufficient for a three-month period English Spanish
Record Cards Adult Record Card  
Utah School Immunization Record (No longer availalbe. Printable
card link below - can be printed on any color paper.)
Lifetime Personal Record (Yellow Card)  
Schedule Cards Adolescent
Childhood 8.5 x 11  
Other Materials Pertussis Tear Pads Surround your Baby double-sided
Pertussis Tear Pads Surround your Loved Ones double-sided
Pertussis Tear Pad Stands  
Perinatal Hepatitis B Lab Testing Form - 2010 version  
International Certificate of Vaccination (ICV)  
Plastic Sleeves for ICV  
Plastic Sleeves  
Next Due Stickers (250 per pad)  
PPV Stickers (500 per roll)  
VFC Stickers (100 per roll)  
HPV Parent Tear Pad double-sided English/Spanish (50 per pad)  
Exemption Forms Personal  
Posters Adult Immunization/You Never Outgrow Vaccinations 11 x 17
Adult Schedule Poster 11 x 17
Back to School Imm Requirements Poster 11 x 17  
Got Vaxed Poster Question Mark 14 x 20  
Got Vaxed Poster Teenagers 14 x 20  
Get the Flu Vaccine Poster 11 x 17  
Pertussis Surround your Baby 11 x 17  
Preteen Doctor Visit 12 x 20
Vaccinate Before you Graduate 11 x 17  
Brochures Get the Flu Vaccine
Hepatitis A What You Should Know
Hepatitis B - Stop the spread
Older Adults Need Shots
Planning a Trip
Preteen Doctor Visit
Protect Children by Protecting Yourself
Questions and Answers: A Guide for Parents about Childhood
Vaccinate Before you Graduate
Vaccine Safety
Tearpads VFC Information Tearpad double-sided English/Spanish  
Please verify your order by entering the random letters (case sensitive) displayed in this image:

Contact Tammy Gresham with any questions (801) 538-9450. Include exact quantities sufficient for a three-month period. Due to limited inventory, your order may be adjusted.

Printable Utah School Immunization Record card here: Utah School Immunization Record