3. Vaccination Promotions
What type of vaccination are you looking for?
Travel vaccination (including Umrah/Hajj)
Immunization for Children
Food Handlers
Dengue Vaccine
Others
Others
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Do you have any known allergies/ fainting after vaccines or medication?
True
False
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Have you received any vaccines in the past 6 months?
True
False
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If you’re getting a travel vaccination, which country are you visiting?
Yes
No
Country
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For pediatric vaccination, what is the child’s age?
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First Name
Last Name
Email
Phone/Mobile
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