Clark university immunization form: Fill out & sign online

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Click ‘Get Form’ to open the Clark University Immunization Form in our editor.
Begin by entering your personal information at the top of the form, including your name, date of birth, and student ID number. Ensure accuracy as this information is crucial for your health records.
Fill in your contact details such as cell phone number and email address. This will help the university reach you regarding any immunization updates.
Indicate whether you will be residing on campus by selecting 'Yes' or 'No' under University Housing.
Complete the Required Vaccines section by entering the dates for each vaccine received. If applicable, check the boxes indicating your immune status for MMR, Hepatitis B, and other vaccines.
If you have had a TB test or chest X-ray, provide the necessary details in the respective fields. Attach any required laboratory reports for titers as instructed.
Finally, ensure that a healthcare provider completes their section by providing their signature and contact information before submitting your form.

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