I confirm that I have provided all my health information on this form to the best of my knowledge.

I authorize the Healthcare Provider at TravelVAX Clinic Inc. to administer vaccine(s) intramuscuarly or subcutaneously. Side effects from vaccination typically resolve within 2 to 3 days and, in most cases, an analgesic (pain killer) such as acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) may be taken to reduce fever and/or discomfort.
Common side effects: soreness, tenderness, redness and/or swelling in the area of the injection site.
Less frequent side effects: mild fever, headache and/or muscle aches.

I agree to remain in the clinic for at least 15 minutes following vaccination(s).

I authorize the Healthcare Provider at TravelVAX Clinic Inc. to administer epinephrine and/or life-saving procedures in the event of a severe allergic reaction.

I authorize the TravelVAX Clinic Inc. to contact me about a follow-up dose if required.

I read and agree to the PRIVACY POLICY and TERMS OF USE outlined on travelvax.ca website.