How do I register as an ImmTrac Client?
To register for ImmTrac participation, you must grant consent in writing. Anyone 18 years or older may consent to participate in ImmTrac. Historical, as well as current, immunizations can be added to their record at any time. Consent is only required one time and is valid for life.*
To do this, you may:
- Download the Immunization Registry (ImmTrac) Adult Consent Form (F11-13366).
Note: A separate form needs to be completed for each adult.
Complete the form, sign and date it. Deliver the completed consent form, along with copies of your immunization records to:
- Any health-care provider registered with ImmTrac
- A local health department or
- Mail to:
Texas Department of State Health Services
Immunization Branch – ImmTrac Group
MC 1946, PO Box 149347
Austin, TX 78714-9347
FAX to:
(512) 776-7790 (Austin)
*You may withdraw this consent at anytime.
How do I remove my child/myself/my family from ImmTrac?
Consent may be withdrawn at anytime by contacting the Immunization Branch. To do this, you may:
Call the Immunization Branch at (800) 252-9152 and request an ImmTrac consent withdrawal form.
Texas Department of State Health Services
Immunization Branch - ImmTrac Group
MC1946, PO Box 149347
Austin, TX 78714-9347
Or by FAX to:
(512) 776-7790 (Austin)
(866) 624-0180 (toll-free)
How can I get a copy of my shot record?
ImmTrac clients who would like to request a shot record must fill out the Authorization to Release ImmTrac Form. To do this, you may download the Authorization to Release ImmTrac History Form (F11-11406). If you are not a current ImmTrac client, your information will not be in ImmTrac.
Individuals who were clients as children will have the opportunity to maintain their childhood immunizations in ImmTrac. From age 18 to 19 they may sign an ImmTrac Adult Consent Form (F11-13366) to retain their immunization information in the registry. After their 19th birthday, that information, by law, will be permanently purged.
Complete the form, sign and date it. Send the completed form, by mail to:
Texas Department of State Health Services
Immunization Branch – ImmTrac Group
MC 1946, PO Box 149347
Austin, TX 78714-9347
Or by FAX to: (512) 776-7790 (Austin)
How can I get more information?
E-mail: ImmTrac@dshs.state.tx.us
Call: 800.252.9152
Write to:
Texas Department of State Health Services
Immunization Branch – ImmTrac Group
MC 1946, PO Box 149347
Austin, TX 78714-9347
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