Form - Dynamic
  Would you like to book your appointment in Kingston or Belleville?        
 
A

days      

 
1
2
3
4

B

Purpose of trip






Where will you be staying?





Possible activities









C

IMMUNIZATION HISTORY
Vaccine Date of Last Dose Vaccine Date of Last Dose
   

D

 

 

 

25/09/2017 (d/m/y)

Note: Most vaccines are generally well tolerated; however, you may experience some soreness, redness and swelling at the injection site. Other adverse reactions may include headaches, fever, fatigue, and muscle pa in. As with any vaccine, an allergic reaction or anaphylactic response could occur.