Nevada WebIZ - Forms

• School Permission Slip
• School Permission Slip (Spanish)
• Nevada WebIZ Enrollment Form
• Nevada WebIZ View Only User Confidentiality Agreement
• Immunization Record Request Form
• Nevada WebIZ Change Form
• VFC Provider Information Change Form
• VFC Vaccine Coordinator Change Form

English

• Disclosure Poster 2010
• Participation Form 2013
• Registry Regulation: Instructions (and flowchart) for Compliance in Your Office 2010

Spanish

• Declaración de Divulgación 2010
• Formulario de Participación 2010
• Regulación del Registro: Instrucciones (y diagrama) para el Cumplimiento en Su Oficina 2010

Submitting Your Enrollment/Application Forms

All enrollment/application forms can be faxed (775-687-7596), emailed to izit@health.nv.gov, or mailed to the address on the forms, “Attn: Nevada WebIZ Help Desk.”

Help Desk Assistance

For Help Desk assistance, please call 775-684-5954. You may also contact the Help Desk by email at izit@health.nv.gov. We are available Monday through Friday, from 8:00am until 5:00pm