6320-B W. Union Hills Dr., Ste. B-2300 Glendale, AZ 85308
Phone:(623) 561-9113    Fax:(623) 561-6148
     
   
 
 
     
Vaccine Information
 
 

ENGLISH                                    SPANISH

 

Diptheria,Tetanus & Pertussis (DTaP)Difteria Tetano Y Tos Ferina (TDaP) 
Tetanos Difteria Y Tos Ferina (TdaP)  
Hepatitis BHepatitis B  
Hepatitis AHepatitis A  
Heamophilus Influenzea Type B (HiB)Influenzae Heamophilus tipa B (HiB)  
Measles, Mumps & Rubella (MMR)Sarampion, Paperas Y Rubeola (MMR)  
PolioPolio  
ChickenPox VaccineVaricella 
Pneumoccal ConjugateNeumococica Conjugada 
Pneumoccal PolysaccharideNeumococica Polisacarida PPV  
MeningococcalMeningococicas 
RotavirusRotavirus  
Influenzas Vaccine-Flu    Contra la Influenza  
Rabies Vaccine  Contra La Rabia 
HPV Vaccine  (Cervarix)Contra el HPV  (Cervarix)
HPV Vaccine (Gardasil)Contra el HPV (Garasil)
Shingles Vaccine  Vacuna Contra La Culebrilla 
Smallpox Vaccine  viruela-vis Smallpox 
Typhoid Vaccine  Vacuna Contra La Fiebre Tifoidea 
Yellow Fever Vaccine Vacuna Contra Fiebre Amarilla 
 
 
 
 
 
 
 
 
(Must be filled out completely, signed and dated for shots to be administered)
      
 
 



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