• Home
• Mission
• About Us
  • History
  • Noteworthy
• Hours
• Services
  • Annual Physicals and Health Maintenance
  • Diagnosis and Treatment of Acute Health Problems
  • Diagnosis and Treatment of Chronic Diseases
  • Participation Physicals
  • Diagnostic Studies
  • Prescribing
  • Referrals
  • Patient Education
  • Immunizations (Travel and Routine)
  • Allergy Shots
  • Collaborating with Health Professionals
• 2012 Flu Clinics
• Make an Appointment
  • How to Schedule an Appointment
  • What to Bring to Your First Appointment
• Travel Health and Immunizations
  • Immunization Questionnaire Forms
• Pediatric Healthcare
  • Your Child's Medical Home
  • Medical Home vs. Emergency Room
  • Resources for Dental Care
• Adult Healthcare
  • When Should You Go To the ER?
• Location
• Staff
  • What is a Nurse Practitioner?
• Billing
  • Participating Insurance Companies
  • Sliding Fee Scale for Uninsured Patients
• KCON Home
• GVSU Home
• Comment Form
• The Rapid Public Transportation

GVSU Family Health Center

• Print
• Site Index
• Contact Us
• Faculty/Staff Directory

Immunization Questionnaire Forms

Before receiving a routine or travel immunization, each patient must fill out one of these forms. Please note that this form must be filled out on the day of your appointment.

Adult Immunization Questionnaire

Pediatric Immunization Questionnaire

Page last modified May 11, 2011