This is a basic COVID-19 Vaccine Questionnaire printable PDF. Quickly get to the point with your vaccination questions. Includes 3 important questions along with name, date of birth, signature, and date.
- Have you had COVID-19 in the past 30 days? Yes / No
- Have you received a covid-19 vaccination? Yes / No
- If you have received the vaccine, did you receive all doses that were required? Yes / No
This PDF cannot be edited, it is for printing only.
WHAT YOU GET (1 PDF File):
• PDF COVID-19 Vaccine Questionnaire Form - 8.5 x 11"
• US Letter Size 8.5 x 11" (portrait)
• Black Content
• White Margins
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