Vaccine Services & Travel Medicine 2025

1. Click ‘Get Form’ to open the Vaccine Services & Travel Medicine document in the editor.
2. Begin by filling out the patient information section. Enter your name, date of birth, address, and phone number clearly in the designated fields.
3. Next, answer the screening questions regarding allergies and previous vaccine reactions. Check 'YES' or 'NO' for each question to ensure accurate medical history is recorded.
4. In the Patient Consent section, read through the provided information about the influenza vaccine. After understanding it, sign and date where indicated to give your consent.
5. Complete the Patient Billing Information section by providing either your Medicare ID or insurance details, including subscriber name and policy number.
6. Finally, review all entered information for accuracy before submitting. Ensure that any required signatures are completed.

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