Immunizations Unit Data Request Form

Please read through the following before submitting your data request:

Please fill out the entire form and provide detailed information.
All fields with an asterisk (*) must be completed.

Part 1: Requester Information

Part 2: Data Request Information

(e.g., "How many people were vaccinated with Gardasil in 2018, 2019, and 2020?")
(e.g., Varicella, Gardasil/HPV, etc.)
Note: See our Texas Vaccines for Children and Adult Safety Net pages for a list of vaccines covered by each program, .
(e.g., December 14th, 2021–Present day, 2017–2018, etc.)
(e.g., count of people vaccinated, count of doses administered, age of people vaccinated, etc.)
(e.g., specific age group, race/ethnicity, county, etc.)
(e.g., increase coverage rates, monitor )
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
2 + 5 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.