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COVID-19 Vaccination Screening Form


If you have your vaccination coupon, you can download, print and complete this form to give to the hospital/clinic you are visiting to receive your vaccination.


Please note, that you will be required to complete the Japanese language form, so please use any other files as a translation guide.



Prevaccination Form - Japanese
.pdf
Download PDF • 364KB

Prevaccination Form - Chinese
.pdf
Download PDF • 368KB

Prevaccination Form - Vietnamese
.pdf
Download PDF • 329KB

Prevaccination Form - English
.pdf
Download PDF • 249KB

Prevaccination Form - French
.pdf
Download PDF • 252KB

Prevaccination Form - Korean
.pdf
Download PDF • 421KB