Duplicate COVID-19 Vaccine Card Request Form

Request a Replacement COVID-19 Vaccine Card
Anyone who received a COVID-19 vaccination from Virtua Health and is need of a replacement CDC Vaccination Record Card can make that request by completing the form below. This service includes individuals vaccinated at the former Burlington County COVID-19 Vaccine Mega-Site at the Moorestown Mall, as well as other off-site clinics performed by Virtua Health.

Alternative Ways to Access your Vaccine Record
MyChart users can find details about their vaccination(s) by logging on to the platform. Click on Menu, My Record, COVID-19 to look up the date, manufacturer, lot number, and location of your vaccination(s). You can also download the information as a PDF.

The NJ Department of Health’s Docket app also makes it easy to securely access your COVID-19 vaccination record. The app is free and available in English and Spanish. Learn more here.

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Routine replacement cards will be mailed via standard USPS mail. Please allow 1-2 weeks to receive your card. Please note that disruptions in the mail service can affect delivery times. If you need to schedule an onsite pick-up of your card, please note that in the text field at the bottom of the page.

Patient's Legal First Name

Field is required

Patient's Legal Last Name

Field is required

Patient's Date of Birth

Field is required

If you are requesting a card for a minor please complete the guardian information.

Guardian's First Name

Guardian's Last Name

Patient's Address

Field is Required

City

Field is Required

State

Field is Required

Zip Code

Field is Required

Phone Number

E-mail

Please enter a valid e-mail

If you would prefer to schedule an appointment for an onsite pick-up of your card, or have any other specific request, please add that information in the text field below. A member of our team will contact you at the number you provided above.

Please only click the “Submit” button once. This form may take 1 to 2 minutes to process.

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Duplicate COVID-19 Vaccine Card Request Form