Vaccine Screening And Consent
CONSENT TO VACCINATION
I HAVE READ OR BEEN EXPLAINED TO ME THE 2018-2019 VACCINE INFORMATION SHEET ABOUT THE SEASONAL INFLUENZA VACCINE AND UNDERSTAND ITS RISKS AND BENEFITS.
I GIVE CONSENT TO Elewell Care Integrative AND ITS STAFF FOR THE VACCINATION OF THIS VACCINE FOR MYSELF OR MY CHILD(REN) UNDER THE AGE OF 18.
NOTICE OF PRIVACY PRACTICES-THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED BY OUR PHARMACY AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
Please contact us for more information:
Organization Name:Elewell Care Integrative
Org Address: 4200 Trabuco Road Irvine,CA 92620
Org Contact Number: 949 861-3170