Vaxin Check Online Clinic Directory
Registration Form

FOR DOCTORS ONLY

Vaxin Check For Adults is Malaysia’s 1st dedicated adult vaccination promotion programme by the Malaysian Society of Infectious Diseases & Chemotherapy, in association with Immunise4Life.

If you are currently offering adult vaccination services and would like to list your practice under our online clinic directory (www.ifl.my/vaxincheck), kindly fill in the form below.

For doctors who wish to learn more about adult vaccination, kindly contact the programme secretariat at Mobile:+603 7496 4880 / Fax:+603 7496 4880, Mondays to Fridays from 10am to 6pm or email matters@ifl.my

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* Doctor's Name

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* MMC Registration Number

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* Clinic Name

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* Clinic Address

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* City/Town

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* Postcode

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* State

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* Email

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* Clinic Tel. No

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* Please indicate which vaccines you offer in your clinic.

Cholera

Haemophilus influenzae type b

Hepatitis A

Hepatitis B

Human Papillomavirus

Influenza

Japanese Encephalitis

Measles

Meningococcal (Conjugate)

Meningococcal (Polysaccharide)

Pneumococcal (Conjugate)

Pneumococcal (Polysaccharide)

Poliomyelitis (IPV)

Rabies

Rubella

Tetanus

Typhoid

Varicella

Yellow Fever

Zoster (Shingles)

Hepatitis A + Hepatitis B

Hepatitis A + Typhoid

MMR

MMR + Varicella

Tdap

Tdap + IPV

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* How did you find out about this directory?

MMA Website

MMA Email Newsletter

Berita MMA

MIMS Doctor

Other (please specify)

For the Immunise4Life secretariat (Ultra Works Sdn Bhd) to list your clinic in the online directory, the secretariat will gather and process your personal information collected through this registration form. Concerned Individuals have a right of access to all information held about them. They also have the right to ask for this information to be rectified or deleted. Concerned Individuals who wish to exercise such rights should contact matters@ifl.my or Mobile: +603 7496 4880 / Fax: +603 7496 4880.

Untuk sekretariat Immunise4Life (Ultra Works Sdn Bhd) menyenarai klinik anda di direktori atas talian, sekretariat akan mengumpul dan memproses maklumat peribadi anda yang didapati di borang pendaftaran ini. Individu yang berkenaan mempunyai hak untuk mengakses semua maklumat peribadi mereka yang dipegang oleh Immunise4Life. Mereka juga berhak meminta maklumat tersebut diperbetulkan atau dihapuskan. Individu yang berkenaan yang berhasrat untuk menggunakan hak tersebut boleh menghubungi sekretariat Immunise4Life di matters@ifl.my atau Mobile: +603 7496 4880 / Fax: +603 7496 4880.

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