Get Rexallca Form

Filling out the Rexallca Form online is a straightforward process designed to facilitate your vaccination against influenza. This guide provides clear, step-by-step instructions to ensure you complete the form accurately and confidently.

Follow the steps to fill out the Rexallca Form online.

1. Press the ‘Get Form’ button to access the Rexallca Form and open it in your preferred editor.
2. Begin by entering the date and your provincial health number in the designated fields.
3. Provide your personal information, including your full name, address, city, postal code, home phone, and mobile number.
4. Select your gender and enter your date of birth (MM/DD/YYYY) and age.
5. If you are completing this form for a child, enter their weight in kilograms and pounds.
6. Fill in the emergency contact details, including their name, relationship to you, and phone number.
7. Answer the flu vaccine questionnaire truthfully by checking 'Yes' or 'No' for each question.
8. Complete the required contact information fields, including your first name, last name, email address, city or town, province, and postal code.
9. Indicate whether you would like to receive the Rexall newsletter by checking the appropriate box.
10. Read and provide consent by signing with your name and date, ensuring you meet all conditions for vaccination.
11. Once you have filled out all the necessary sections, save your changes. You may also download, print, or share the completed form as needed.

Start filling out your Rexallca Form online today for a smooth vaccination experience!