Get the free Meningococcal Meningitis Vaccination Request Form - nymc

This form is required for students to acknowledge they have received information about meningococcal meningitis and the availability of the vaccine, as mandated by New York State Public Health Law.

How to fill out meningococcal meningitis vaccination request

How to fill out Meningococcal Meningitis Vaccination Request Form

1. Obtain the Meningococcal Meningitis Vaccination Request Form from your healthcare provider or relevant website.
2. Fill in your personal details including your name, date of birth, and contact information.
3. Provide information about your medical history and any prior vaccinations you have received.
4. Indicate the reason for the vaccination request, such as attending college or traveling to particular regions.
5. Complete any sections that ask about consent or parental approval if the applicant is a minor.
6. Review the form for accuracy and completeness.
7. Submit the form to your healthcare provider or the appropriate vaccination clinic as instructed.

Who needs Meningococcal Meningitis Vaccination Request Form?

1. Individuals planning to attend college or university, especially in dormitory settings.
2. Travelers going to regions where Meningococcal disease is common.
3. Individuals with certain medical conditions that may increase their risk for Meningococcal disease.
4. Students entering the military or staying in close living quarters.
5. Anyone recommended for the vaccine by their healthcare provider.

People Also Ask about

How to get meningitis vaccine certificate?

How it works? Fill the form and book an appointment. Free consultation by INVC Vaccine Expert. INVC team schedules the Vaccination at your preferred date and time. Get Vaccinated at home or at our network of Vaccination centers. Download internationally valid digital Vaccination certificate.

How much does the meningococcal vaccine cost?

Pediatric/VFC vaccine price list VaccineBrandname/ TradenameCDC Cost/ Dose Meningococcal Conjugate (Groups A, C, Y and W-135) F Menveo® two-vial $111.986 Meningococcal (Groups A, B, C, W and Y-135) F Penbraya™ $189.35 $189.35 Measles, Mumps and Rubella (MMR) B M-M-R®II $26.34540 more rows • May 1, 2025

How do you get the meningococcal meningitis vaccine?

How to get the MenACWY vaccine. Teenagers are usually given the MenACWY vaccine at school when they're 13 or 14 years old (school year 9 or 10). If you missed having the vaccine when you were at school, you can still get it up until the age of 25. Ask your GP about getting vaccinated.

What is the meningococcal vaccine in English?

Persons eligible for the free vaccine can visit their local council, general practitioner (GP) or pharmacy to receive the free vaccine. If you are not eligible for the free vaccine but wish to reduce your risk of meningococcal disease, you can purchase the vaccine on prescription.

Does Walgreens do meningococcal vaccines?

Meningococcal vaccine Vaccines offered at Walgreens vary by state, age and health conditions. Talk to your local pharmacist about availability.

Can I get meningitis vaccine at CVS?

Vaccines. We make it easy to get meningitis, TDaP, flu, tetanus, COVID and other shots. Conveniently get yours from a trained MinuteClinic® provider.

Do pharmacies do meningitis vaccinations?

Do you need the meningitis ACWY vaccine? If you have not had this vaccination before or you require it before travelling, you can get it through your pharmacist or GP. You will have a consultation and one dose of vaccine (you only need one dose).

For pdfFiller’s FAQs

What is Meningococcal Meningitis Vaccination Request Form?

The Meningococcal Meningitis Vaccination Request Form is a document used to request vaccination for individuals at risk of meningococcal disease. It ensures that individuals receive the necessary vaccination in accordance with public health guidelines.

Who is required to file Meningococcal Meningitis Vaccination Request Form?

Individuals attending certain educational institutions, military recruits, healthcare workers, or those traveling to areas with high rates of meningococcal disease may be required to file the form as part of their health compliance.

How to fill out Meningococcal Meningitis Vaccination Request Form?

To fill out the form, provide personal information such as name, date of birth, and address. Indicate the reason for the vaccination request, provide vaccination history, and sign the form to confirm the accuracy of the information submitted.

What is the purpose of Meningococcal Meningitis Vaccination Request Form?

The purpose of the form is to formally document the request for vaccination against meningococcal disease and to ensure that individuals who are at risk receive appropriate immunization.

What information must be reported on Meningococcal Meningitis Vaccination Request Form?

The form must include personal details such as the individual's name, contact information, date of birth, medical history, vaccination history, and the specific reason for the vaccination request.