FORMS
Listed below for your convenience is our patient forms for
the IMUnization Clinic and for IMU Southwest Immunization Clinic for Children, Adults, and International Travelers. Please print and complete all forms prior to your visit to our clinic. Please go to our
Vaccine Information Sheets page to review and print information sheets for the immunization(s) and/or tests you would like to receive. Consent forms only need to be completed if this will be your
first visit to our facility. Anyone can now consent to having their immunization history maintained in ImmTrac. ImmTrac is the statewide immunization registry for the state of Texas which will maintain a copy of your immunization history for life. If you are an adult and would like your information added to this registry, please complete the Adult ImmTrac Consent form also. We look forward to greeting you soon!
Forms for The IMUnization Clinic - North Office Only
Consent Form for Routine Child/Adolescent/Adult Visit
Consent Form for International Travelers
Additional Forms for Children
[Both forms need to be completed for anyone 18 years of age and under receiving routine/recommended immunizations]
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Forms for IMU Southwest Immunization Clinic ONLY
Consent Form for Routine Child/Adolescent/Adult Visit
Consent Form for International Travelers
Additional Forms for Children
[Both forms need to be completed for anyone 18 years of age and under receiving routine/recommended immunizations]