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For patients: The following questions will help us determine which vaccines you may be given today 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your personal information, including your name and date of birth. Ensure accuracy as this information is crucial for your vaccination record.
- Proceed to the Screening Questionnaire section. For each question, select 'Yes', 'No', or 'Don't Know' based on your current health status. If any question is unclear, feel free to ask your healthcare provider for clarification.
- After answering all questions, complete the form by signing and dating it at the bottom. This confirms that the information provided is accurate.
- Finally, indicate whether you have brought your immunization record card with you. This helps ensure that all vaccinations are properly documented.
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