Immunization Requirements Form
LCC must receive copies of the blood titer results. Booster immunizations may be needed if not showing immunity.
Please ask your physician to fill out the form entirely and place the facility stamp at the bottom of the form.
Influenza Statement of Refusal Form
Hepatitis B Declination Form
Tdap Declination Form
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.)