Documents to be completed for vaccination

*Documents required to be completed for vaccination (preferable to be completed prior to arriving at vaccine clinic):

• Patient Consent Questionnaire Form:

  • English: Spanish: 
  • Important note:  Parent/Guardian of unaccompanied minors must initial/sign/date the “Parent/Legal Guardian” line in section C prior to sending their minor to the vaccination clinic.

• Insurance Attestation Form:

  • English:  Spanish: 

• Unaccompanied Minor Consent Form: 

  (to be completed at home by a parent/guardian if the minor will be unaccompanied during vaccination)
  • Important note:  We will not vaccinate any unaccompanied minor who does not have a completed Unaccompanied Minor Consent Form in his/her possession.

Scheduling Links:

https://app.myirmobile.com/auth/register

https://app.myirmobile.com/auth/event/79da7b1a-bd7f-11eb-a840-e7065952e45e