外国人接种疫苗知情同意书

Hello, we are the staff of the street community. Now we are statisticing the people who need to be vaccinated with COVID-19 vaccine, and the cost of the vaccination  is 200 RMB. May I ask you some questions?

1. Do you agree to be vaccinated?

2. Are there any contraindications or other reasons for not being vaccinated?

If you agree to be vaccinated, please sign your name for confirmation. Thank you for your cooperation.

您好,我们是街道社区的工作人员,现在正在统计需要接种新冠疫苗的人员,接种费用为200元人民币。请问您:

1.是否同意接种新冠疫苗?

2.是否有接种新冠疫苗的禁忌症或者其他不能接种的原因?

如同意接种,请签字确认:

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