Forms:
Immunization Requirements Form
LCC must receive copies of the blood titer results. Booster immunizations may be needed if not showing immunity.
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Physical Form
Please ask your physician to fill out the form entirely and place the facility stamp at the bottom of the form.
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Influenza Statement of Refusal Form
| influenza_statement_of_refusal.doc |
Hepatitis B Declination Form
| hep_b_statement_of_refusal.doc |
Tdap Declination Form
| tdap_statement_of_declination.doc |
Please print out and sign the attached form if you'd like to decline the Tdap vaccination. (LCC can provide a printed copy as well.)