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目黒区高齢者定期予防接種予診票転送申請書
healthseniorsadmin
This application form is used to transfer the pre-examination sheet for elderly periodic vaccination in Meigoku Ward to another address. The applicant fills in name, address, phone number, the destination address, desired year, and relationship to the person receiving the vaccination. Required documents such as identification and a copy of the health insurance card must be attached and submitted to the ward office.
| What | 高齢者定期予防接種の予診票を別住所へ転送する申請 |
|---|---|
| Who | 申請者（高齢者本人または代理人） |
| When | 記載なし |
| Where | 目黒区 |
| How | フォームに必要事項を記入し、本人確認書類・健康保険証等の写しを添付して区役所に提出する |
| Deadline | 記載なし |
| Contact | 記載なし |
Open the original PDF ↗ 1 pages
Source page: https://www.city.meguro.tokyo.jp/hokenyobou/kenkoufukushi/yobousesshu/r6_vaccination.html
Checked 2026-11-01. This page restates the PDF in a fixed structure; nothing is added or removed. Where the PDF does not say, the field reads "not stated". The original Japanese PDF is authoritative — confirm dates and conditions there.