COVID-19 Vaccination Screening Form
If you have your vaccination coupon, you can download, print and complete this form to give to the hospital/clinic you are visiting to receive your vaccination.
Please note, that you will be required to complete the Japanese language form, so please use any other files as a translation guide.
Prevaccination Form - Japanese
Download PDF • 364KB
Prevaccination Form - Chinese
Download PDF • 368KB