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20182019 INFLUENZA CONSENT FORM Information about person to be vaccinated (please print) Last Name:for children: office use onstage:First Name:Child needs second doses:Date of Birth:Masses if child

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How to fill out 2018-2019 influenza consent form

01

Obtain a copy of the 2018-2019 influenza consent form from the healthcare provider or educational institution.

02

Read the form carefully to understand the information and requirements.

03

Fill in your personal information such as your name, date of birth, address, and contact details.

04

Provide details about your current health status, any allergies, and medical history.

05

Sign and date the form to acknowledge your consent for receiving the influenza vaccine.

06

If the form requires a parent or guardian's signature, make sure they complete that section.

07

Return the completed form to the healthcare provider or educational institution as instructed.

Who needs 2018-2019 influenza consent form?

01

Individuals who want to receive the 2018-2019 influenza vaccine need to fill out the influenza consent form. This may include adults and children who are eligible for the vaccine based on their age and health condition. The specific criteria for who needs the form may vary depending on the healthcare provider or educational institution administering the vaccine.

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