Get Opt Out-in Forms, 12-05.doc

Filling out the Opt Out-In Forms, 12-05.doc is a straightforward process that allows users to manage their immunization data within the Virginia Immunization Information System. This guide provides step-by-step instructions to ensure that you can complete the forms accurately and efficiently.

Follow the steps to complete the Opt Out-In Forms online.

1. Press the ‘Get Form’ button to obtain the form and open it in your preferred online editing tool.
2. Begin by providing the name of the client in the designated fields. Enter the last name, first name, and middle name as appropriate.
3. Fill in the date of birth using the format MM/DD/YYYY, and indicate the sex and race of the client by selecting the relevant options.
4. Complete the fields for the name of the parent or guardian, including last name, first name, and middle name.
5. Specify the relationship of the parent or guardian to the client and include a telephone number with the area code.
6. Provide the full street address, including city, state, and ZIP code.
7. Review the statement indicating the request for removal (Opt-Out) or reinstatement (Opt-In) from the Virginia Immunization Information System, and ensure you understand its implications.
8. Sign and date the form in the indicated areas using the format MM/DD/YYYY.
9. Once completed, you can save changes, download the filled form, or print it out for mailing.

Take control of your immunization data by completing your forms online today.