Forms download

This page provides you with forms and patient education materials that you need for flu vaccine and medication assistant training, CPR and immunization.  Please read each form carefully before signing.  If you have any questions regarding these forms or the contents herein, feel free to contact our main office at 301-460-6372.  You will need Acrobat Reader to view or print these forms in Portable Document Format (PDF). You should have Adobe Acrobat Reader version 5 or higher to view these documents.

Clinic forms

Flu clinic contract
Flu vaccine consent form (English), (Spanish)
Flu vaccine information sheet (VIS) (English), (Spanish)
Flu vaccine consent form - Safeway
Customer Receipt
Clinic Schedule
Flu Vaccine Reaction form
Post-Service Flu Vaccine Information form
Is it a Cold or the Flu?
Is it a Flu Shot Fact or a Myth? (English), (Spanish)
Three top reasons to get a Flu Shot!
Medication Technician training
Medication Technician Training Contract
Medication Technician List
Medication Technician Evaluation form
Vaccine Information Sheet
Diphtheria, Tetanus and Pertussis (Vaccine Information Sheet (VIS)
Haemophilus Influenzae Type b (Hib) (VIS)
Hepatitis A - (VIS)
Hepatitis B - (VIS)
Hepatitis B - Consent Form
Pneumonia - (VIS)
Polio - (VIS)
Japanese Encephalitis (VIS)
Meningococcal (VIS)
Measles, Mumps and Rubella (VIS)
Rabies (VIS)
Tetanus and Diphtheria (VIS)
Tdap (VIS)
Typhoid (VIS)
Chickenpox (VIS)
Yellow Fever (VIS)