To confirm your vaccination appointment please complete the form below. A printed version will require your signature when you arrive for your appointment.
Influenza Vaccine Consent Form
NOTICE: Information about your immunization will be recorded in the Manitoba immunization Monitoring System (MIMS) and used for surveillance by Manitoba health to produce immunization records, monitor vaccine uptake and how well vaccines are working., and may also be used for research. all information recorded in MIMS will be protected in accordance with he Protection or Privacy provision of the Personal Health Information Act.