Declination form 2026

1. Click ‘Get Form’ to open the declination form in the editor.
2. Begin by entering the facility name in the designated field at the top of the form.
3. Read through the provided information regarding the influenza vaccine, ensuring you understand its risks and benefits.
4. In the section where you indicate your choice, select one of the options: either declining the vaccine or stating that you have already received it this flu season.
5. If you are declining, simply check the first box. If you have already received it, check the second box and fill in where you received it.
6. Print your name clearly in the 'Employee’s Name' field, followed by your signature and date to finalize your declination.

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