Immunizations Forms

Immunization forms

The descriptions and forms below are intended to help speed up the immunizations process. Please fill out the following forms, if possible, before your visit.

If you are coming to get any kind of shots at the immunizations clinic, please fill out the appropriate screening form, either adult or teen/child.

If you are requesting a “live virus vaccine” such as MMR (measles/mumps/rubella) or Varicella (a.k.a. Chicken Pox), please complete the “live virus” form in ADDITION to the adult or teen form above.

Flu season typically ranges from November until at least March. Before getting the flu vaccine, please fill out either the English OR Japanese Influenza screening form.

If you do not have an immunization record in your chart, please fill out the appropriate form. (Please also fill a separate one out for your child/children as well.)

If you are due for your yearly PPD screening, please fill out the form below: