General immunization consent form

[USNAredrock]

Hi all, one of the items in the PTR is the General immunization consent/ additional medical info that you are supposed to bring to I-day. I'm just a little confused on how to fill this paper out, especially the top section...
If anyone has any advice I would greatly appreciate it! Thanks

 

[Cerberi]

Can you be more specific?

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Usna 2021 blb parent page

There is a lot of discussion on it including scans of the document

There is also a phone number for medical providers to call if questions

They don't ask where your medical degree is from