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