Immunization Form printable pdf download

Immunization Form

Important!

Do Not Delay!

Immunization Form

REQUIRED

for you to proceed with

Admissions for Clinical Rotation

at Miller’s Nursing Review

Obtaining proof of immunizations may be a

time-consuming process, so start now!

Each new student accepted for admission must submit, prior to registration, a completed Immunization Form

provided by Miller’s Nursing Review.

All students, regardless of age, must complete and return the

Immunization Form to be reviewed for compliance. This includes documented proof of immunity to Measles

(Rubeola) and German Measles (Rubella), Mumps, Varicella, Hepatitis B and the annual Flu Shot.

You will NOT be able to attend clinicals without completing this requirement. Submit your Immunization Form

and documented proof to Miller’s Nursing Review prior to your orientation date so that you may register for

classes during your orientation session. We recommend you start this process early.

Completed forms may be faxed or mailed to Miller’s Nursing Review. Sorry, no emails accepted!

Fax: 407.846.8581

Mail:

Miller’s Nursing Review

Attn: Immunization Records

2151 Consulate Drive, Suite 10

Orlando, Florida 32837

For more information on Immunizations, please visit our Frequently Asked Questions page.

MEDICAL EXEMPTIONS

If a student has certain medical conditions and/or contradictions to a vaccine, please contact our office by

calling 407.846.3636, or email us, to request an exemption. No forms will be accepted via email, this is due to

health information privacy laws.

Immunization Form