Details:

Patient Name: The following questions will help us determine if there is any reason you should not get the COVID-19 vaccine today.

If you answer “yes” to any question, it does not necessarily mean you should not be vaccinated. It just means additional questions may be asked. If a question is not clear, please ask your healthcare provider to explain it.

Subjects: Document Type: Collection(s): Main Document Checksum: urn:sha256:ff7d6108af109831d3336fad461c452664438cf9b49fd2ef810f787799b513ab Download URL: File Type:

Supporting Files

No Additional Files

You May Also Like

[PDF - 623.40 KB] National Center for Immunization and Respiratory Diseases (U.S.). Division of Viral Diseases. Aug. 28, 2020 Description:

Updated Aug. 28, 2020Strengthening the public health workforce. Enhancing frontline public health capacity in state, local, tribal, and territorial he.

[PDF - 623.40 KB] [PDF - 623.40 KB] [PDF - 623.42 KB] National Center for Immunization and Respiratory Diseases (U.S.). Division of Viral Diseases. Aug. 29, 2020 Description:

Updated Aug. 29, 2020Strengthening the public health workforce. Enhancing frontline public health capacity in state, local, tribal, and territorial he.

[PDF - 623.42 KB] [PDF - 623.42 KB]

Checkout today's featured content at stacks.cdc.gov

Exit Notification/Disclaimer Policy

Links with this icon

The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website.
Linking to a non-federal Website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
You will be subject to the destination website's privacy policy when you follow the link.
CDC is not responsible for Section 508 compliance (accessibility) on other federal or private websites.