Forms
This form allows you to provide immunization information for entry into NMSIIS.
CDC-Revised document as COVID-19 Vaccine Program Provider Agreement
CDC-Supplemental document as COVID-19 Vaccine Redistribution Agreement
This form may be used by adult patients aged 19 and older to provide vaccination consent to a healthcare provider.
Got Shots Fillable Form
Got Shots? Fillable Form - Eng
Got Shots? Fillable Form - Esp
This form should be used as Consent for COVID-19 Vaccinations
This form should be used as Consent for COVID-19 Vaccinations
This form should be used as Consent for COVID-19 Vaccinations
This form should be used to report out of range temperature incidents and submit a troubleshooting record to the vaccines for children program.
Cibola, McKinley, San Juan, Sandoval, Torrance, and Valencia
Chaves, Curry, DeBaca, Lincoln, and Quay
Eddy, Lea, Lincoln, and Roosevelt
Complete this log when transporting vaccines to an alternate or back-up refrigerator, or when transferring to another provider.
This is a customizable form for use by schools to collect consent from parents so students' historic immunization records may be added to NMSIIS.
This form is to be used for needles/syringes, and e-kit medications and is for Vaccines for Children Approved Sites Only.
This is the letter addressed to parents or legal guardians to determine whether or not a child is to be vaccinated at school. This letter is to be sent out with the VFC school immunization consent form.
VFC Middle School Vaccination Letter/Permission Form (Spanish)