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INFLUENZA VACCINATION WRITTEN DECLINATION FORM DO NOT WANT A FLU SHOT. I acknowledge that I am aware of the following facts: Influenza is a serious respiratory disease; on average, 36,000 Americans
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The form is written to document an individual's decision to decline receiving the influenza vaccination.
Individuals who choose not to receive the influenza vaccination are required to file the form.
The form can be filled out by providing personal information and indicating the reason for declining the influenza vaccination.
The form is used to track individuals who have declined the influenza vaccination for medical or personal reasons.
The form typically includes the individual's name, contact information, reason for declining the influenza vaccination, and signature.
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