Pediatric Immunization Materials
Please use this form to request immunization materials from the Philadelphia Immunization Program. Any active VFC providers may request materials.
VFC Stickers
Place these stickers on the vaccine in your storage unit to differentiate VFC and Private vaccine.
Number of sticker sheets requested
24 stickers per sheet (limit 30 sheets per order)
Your answer
Do Not Unplug Stickers
Number of "Do Not Unplug" stickers requested
6 stickers per sheet
Your answer
Laminated Childhood Immunization Schedule, 2017
Number of laminated childhood immunization schedules requested
Your answer
Immunization Passport
Yellow immunization passports are used to record a patient's vaccine history.
Number of immunization passports requested
Your answer
HPV Fact Sheet
Number of HPV Fact Sheets requested
Your answer
Postcard Version: "Feeling Easy Breezy"
Thanks to vaccines
Number of "Feeling Easy Breezy" postcards requested
Dimensions: 4" x 6"
Your answer
Postcards Version: "Living Life Like a Boss"
Thanks to vaccines
Number of "Living Life Like a Boss" postcards requested (NOTE: temporarily out of stock)
Dimensions: 4" x 6"
Your answer
Postcard Version: "Full-Time Adventuring"
Thanks to vaccines
Number of "Full-Time Adventuring" postcards requested
Dimensions: 4" x 6"
Your answer
Postcard Version: "Ready to Blast Off"
Number of "Ready to Blast Off" postcards requested
Dimensions: 4" x 6"
Your answer
Postcard Version: "Starting Out on the Right Note"
Thanks to vaccines
Number of "Starting Out on the Right Note" postcards requested (NOTE: temporarily out of stock)
Dimensions: 4" x 6"
Your answer
Postcard version: "Your child's shots are due" (English)
Number of "Your child's shots are due" (English) postcards requested:
Your answer
Postcard version: "Your child's shots are due" (Spanish)
Number of "Your child's shots are due" (Spanish) postcards requested
Your answer
Postcard Version: "Reaching New Heights"
Thanks to vaccines
Number of "Reaching New Heights" postcards requested
Dimensions: 6" x 4"
Your answer
Poster: "Living Life Like a Boss"
Thanks to vaccines
Number of "Living Life Like a Boss" posters requested
Dimensions: 11" x 17"
Your answer
Poster: "Living Large"
Thanks to vaccines
Number of "Living Large" posters requested (NOTE: temporarily out of stock)
Dimensions: 17" x 11"
Your answer
HPV Poster with Girl Photo
HPV vaccine is cancer prevention
Number of "girl" HPV posters requested
Dimensions: 11" x 17"
Your answer
HPV Poster with Boy Photo
HPV vaccine is cancer prevention
Number of "boy" HPV posters requested
Dimensions: 11" x 17"
Your answer
HPV Poster with Door Graphic
Closing the door to cancer
Number of "door" HPV posters requested
Dimensions: 11" x 17"
Your answer
CDC Pink Book. 13th Edition 2015
Number of CDC Pink Books requested (NOTE: temporarily out of stock)
Your answer
Certificate of Immunization (package of 50)
Number of Certificates of Immunization packages requested (each package contains 50)
Your answer
Medical Plans (package of 50)
Number of Medical Plan packages requested (each package contains 50)
Your answer
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms