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VACCINE CHECKLIST
This form is to corm the applicant has received all the required vaccinations. APPLICANT
Name:
Address:
City:Province:Phone:Fax:Postal Code:AGE: 12 MONTHS TO 4 YEARS
The Vainest
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How to fill out vaccine checklist
How to fill out vaccine checklist
01
Obtain a copy of the vaccine checklist form from a healthcare provider or vaccination clinic.
02
Fill in personal information such as name, date of birth, and contact details.
03
Provide information about any medical conditions or allergies that may affect vaccine administration.
04
Indicate any previous vaccinations or medications that may be relevant.
05
Sign and date the form to confirm that the information provided is accurate.
Who needs vaccine checklist?
01
Anyone who is seeking vaccination from a healthcare provider or vaccination clinic may be required to fill out a vaccine checklist.
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