Consent Form Meningococcal B Vaccine 

Please select
I have read the information in the Vaccine Information Statement about the disease and vaccine. I understand the benefits and risks of the vaccine. I understand that this is a two vaccine series. By signing below, I request the vaccine selected be given to the person named on this consent who I am authorized to sign for. I understand NRHA may release immunization records to other medical or school personnel on as as needed basis with the information being treated in a confidential manner.
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2025
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