Personal Health Information Updates and COVID-19 Vaccine Receipt Access

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Please use this form to request assistance in adjusting errors or omissions in your Personal Health Information or Personal Information (related to COVID-19 vaccinations) that is held by the WECHU.

Please provide your contact information.

A first name, last name, phone number, and email address are required. Please only enter your 10 digit phone number (without spaces, parentheses, or hyphens). Please ensure you have entered a valid email address.

First name:
Last name:
Phone number:
Confirm phone number:

Please enter only the 10 digits of your phone number with no spaces or dashes (e.g., 5555555555).

This person will be contacted if further information is required and to confirm appointment times.

Would you like to add an email address to your request?

We may use this email address to contact you. If you add an email address, you will also receive a receipt by email of your request.

Please enter and confirm your email address.

Please check the format of your answer.

Email Address:
Email Address Confirmation:

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