Get Influenza Vaccine (fluad) Consent Form 2016/2017

Filling out the influenza vaccine consent form is an important step towards your health and safety. This guide provides clear instructions on how to complete the INFLUENZA VACCINE (Fluad) CONSENT FORM for the 2016/2017 season online, ensuring a smooth process.

Follow the steps to complete your consent form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Fill in your last name and first name accurately in the specified fields.
3. Enter your date of birth by selecting the year, month, and day from the dropdown menus.
4. Indicate your age in the respective field following your birth date.
5. Provide your complete address, including street, unit/apartment number, city, and postal code.
6. Fill in your daytime and evening telephone numbers as required.
7. Respond to the question about any chronic medical condition by checking ‘Yes’ or ‘No’. If you select ‘Yes’, specify the condition in the provided space.
8. Answer the allergy question in the same manner: indicate ‘Yes’ or ‘No’ and provide details if applicable.
9. Read the information about the influenza vaccine located on the back of the consent form and ensure your questions have been answered satisfactorily.
10. Add your signature in the designated area and date the form appropriately.
11. If you are a clinic staff member, utilize the section for clinic use only, ensuring proper client identifiers are documented and vacci- nation details are recorded.
12. After completing the form, save your changes. You can then download, print, or share the form as needed.

Ensure your vaccination is processed smoothly by completing your consent form online today.