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20172018 Informed Consent to Receive Vaccines First Name:Last Name:Date of Birth:Street Address: City: Phone: (State:)Zip:Mobile/Landline (circle one)Male/Female (circle one)Drug Allergies Physician:Physician
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Mobile/landline circle one refers to the section on a form or document where the individual is required to indicate whether they primarily use a mobile phone or a landline phone.
Any individual filling out a form or document that requires information about the type of phone they primarily use.
To fill out mobile/landline circle one, simply mark whether you primarily use a mobile phone or a landline phone in the designated section.
The purpose of mobile/landline circle one is to gather information about the primary communication device used by the individual.
The individual must report whether they primarily use a mobile phone or a landline phone.
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