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Influenza Vaccine Consent Form

Category:

Immunisation

Council will offer the seasonal influenza vaccine for all public immunisation sessions and dedicated flu only sessions across various locations and times within Maroondah.

Read more about the 2019 Flu Program

Influenza Vaccine Consent Form (pdf, 169KB)

Influenza Vaccine Consent Form (docx, 68KB)

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Maroondah City Council is committed to protecting your privacy as prescribed by the Privacy & Data Protection Act 2014 and the Health Records Act 2001. The information you provide on this form is being collected by Maroondah City Council for the strict purpose of conducting Council business. Your information will not be disclosed to any external party without your consent, unless Council is required or authorised to do so by law. Failure to provide the information requested may make you ineligible to receive the service or be part of an event/function that is the subject of this form. Any access to the information, amendments that may be required or any privacy enquiries may be directed to Council's Privacy Officer & Health Records Officer on 9298 4211 or email privacy@maroondah.vic.gov.au