Get Immunization Form - Derby High School

This guide provides comprehensive instructions on how to complete the Immunization Form for Derby High School online. It will ensure that users can accurately fill out the required fields and submit the form with ease.

Follow the steps to successfully complete the Immunization Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by entering the student's name in the designated field at the top of the form. Ensure that the name matches the official documentation for accuracy.
3. Input the student's address in the specified address section, making sure to include all relevant details such as street address, city, state, and ZIP code.
4. Provide the name of the parent or guardian along with their phone number in the designated fields for contact information.
5. Enter the student's birthdate in the format MM/DD/YYYY. This information is crucial for verifying age-related vaccination requirements.
6. Record each vaccine received by the student. For each vaccine type (e.g., DTaP, Hepatitis B), document the date of each dose received in the corresponding fields, ensuring accuracy.
7. If applicable, indicate any history of illness, such as chickenpox, by checking the appropriate boxes and provide relevant dates.
8. The healthcare provider must sign the form in the designated section, confirming the accuracy of the recorded vaccination information.
9. Users should review the completed form carefully to ensure all fields are filled out accurately before saving or printing.
10. Once all sections are complete, save the changes and proceed to download, print, or share the form as needed.

Ensure your child's immunization records are up to date by completing the form online today.