Printable Proof Of Flu Shot Form – The information you provide to complete this form indicates you understand the benefits and risks of receiving the influenza vaccine, as indicated in. If patient is receiving an influenza vaccine, please complete: Have you ever had any of the following: Walgreens will send vaccination information from this visit to your doctor/primary care provider using the contact. _____ (first) (middle) (last) child’s birthday____/____/____ & age_____ (if. Have you received any vaccinations in the last 6 weeks? Influenza vaccine, before july 1, 2023, (the two doses need not have been received during the same season or consecutive seasons) should. Have you ever had a flu shot before?
