Adult materials ordering form
Please use this form to request immunization materials from the Vaccines for Adults at Risk (VFAAR) Program. Any active VFAAR providers may request materials.
Adult vaccination tri-fold pamphlet
Number of adult vaccination tri-fold pamphlets requested:
Your answer
VFAAR Vaccine Stickers
Number of VFAAR sticker sheets requested (24 stickers per sheet; limit 30 sheets per order)
Your answer
Operating Your Digital Data Logger - Stop Guide
Number of Stop Guides requested
Your answer
Operating Your Digital Data Logger - Start Guide
Number of Start Guides requested
Your answer
"Do Not Unplug" stickers
Number of "Do not unplug" stickers requested
Your answer
Adult Immunization Records
Number of immunization passports requested
Your answer
Laminated Adult Immunization Schedule, 2019
Number of laminated adult immunization schedules requested
Your answer
Shingles Fact Sheet
Number of Shingles Fact Sheets requested
Your answer
Adult Vaccination Poster 1 (limit 5 per order)
Number of Adult Vaccination Poster 1
Your answer
Adult Vaccination Poster 2 (limit 5 per order)
Number of Adult Vaccination Poster 2
Your answer
Adult Vaccination Poster 3 (limit 5 per order)
Number of Adult Vaccination Poster 3
Your answer
Adult Vaccination Poster 4 (limit 5 per order)
Number of Adult Vaccination Poster 4
Your answer
What other adult immunization materials would help you and your practice?
Your answer
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