PATIENT INFORMATION & CONSENT FORM FOR INFLUENZA CLINICS

 

PLEASE PRINT AND COMPLETE  FOR  ALL  CHILDREN and CAREGIVERS RECIEVING INFLUENZA VACCINES.     

PLEASE BRING IT ALONG WITH OHIP INFORMATION WITH YOU FOR THE VISIT

FAILURE TO HAVE A COMPLETED FORM WITH YOU MAY RESULT IN A DELAY FOR YOU GETTING THE VACCINATION !

 

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