Addendum to Td Vaccine (Tetanus and Diphtheria) Vaccine ...: Fill out & sign online

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Click ‘Get Form’ to open it in the editor.
Begin by filling in the name of the person receiving the vaccine. Ensure you include their last name, first name, and middle initial for accurate identification.
Next, enter the birthdate in the format mm/dd/yy and select their sex by circling either 'M' for male or 'F' for female.
Complete the address section with street, city, county, state (TX), and zip code to provide a full contact address.
In the signature field, either the person receiving the vaccine or an authorized individual (like a parent or guardian) should sign. Make sure to date this signature accurately.
For clinic use, ensure that all relevant fields such as clinic address, date vaccine administered, manufacturer details, lot number, site of injection, title of administrator, and date VIS given are filled out correctly.

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