Vaccination Forms

For patients: The following questions will help us determine which vaccines you may be given today. If you answer “yes” to any question, it does not necessarily mean you should not be vaccinated. It just means additional questions must be asked. If a question is not clear, please ask your healthcare provider to explain it

If you haven NOT filled a prescription OR had a vaccination before at Lopez Island Pharmacy please fill out the new patient form first, then you can proceed and fill out the Immunization Questionnaire.





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