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2017-2018 Influenza vaccine release form

2017-2018 Influenza vaccine release form-2026

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The document is an influenza vaccine release form from Arizona State University for the 2017-2018 season. It includes a statement of understanding regarding the vaccine's benefits and risks, a liability release for ASU, and a series of health-related questions to assess eligibility for vaccination. The form requires personal information from the individual receiving the vaccine and is intended for use by faculty and staff.

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Click ‘Get Form’ to open the 2017-2018 Influenza vaccine release form in our platform.
Begin by reviewing the Vaccine Information Statement provided. Ensure you understand the benefits and risks associated with the vaccine.
Fill in your personal information in the designated fields, including your last name, first name, initial, ASU ID number, and date of birth.
Answer all health-related questions by checking 'Yes' or 'No' for each item listed. Be thorough and honest to ensure your safety.
Indicate your preferred site of injection (Left or Right Deltoid) by selecting the appropriate option.
Review all entered information for accuracy before signing. Once confirmed, provide your signature in the designated area.
Finally, select whether to bill the vaccination to your ASU account and ensure that all necessary details are completed before submitting.

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