Admin: Document Capture 2017-01-23T11:46:31+00:00

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  • IMAGE CAPTURE


  • Located at the bottom, right corner of the Influenza Vaccine Patient Agreement.

  • IDENTIFICATION


  • GENDER, DATE OF BIRTH and ADDRESS must be printed on the form of Identification.
    Accepted file types: jpg.

  • INSURANCE


  • Accepted file types: jpg.
  • Accepted file types: jpg.