SAMPLE

I decline the vaccine today because I have already had a flu shot this year. Clinic where vaccinated Date vaccinated (Approximate is OK.) Signature Date signed We will count you as vaccinated. Influenza vaccine declination . Written declination is required! I acknowledge that I am aware of the following facts: ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download

To fulfill the demand for quickly locating and searching documents.

It is intelligent file search solution for home and business.

Literature Lottery

Related searches