News / 2021.09.07

For your Coronavirus vaccine, you can use this “Pre Vaccination Screening Questionnaire” multi language tool

No registration and no fees, with 17 languages available from input to print

We thought about the necessary documents you need for your Coronavirus vaccination:
Vaccination Vouchers, Pre Vaccination Screening Questionnaire and ID documents
and we thought about a way for you to fill in the “Pre Vaccination Screening Questionnaire”, which requires Japanese.

This is a tool created for those who cannot read Japanese, or have issues with Kanji based text. Now, everyone can use this free multilingual tool for filling and printing the Questionnaire in 17 languages.  

No registration and no usage fees. You can use the tool just by accessing the URL, so you can share this with family and friends.

《Available Languages》
Indonesian, Italian, Russian, Thai, Spanish, Turkish, Korean, German, French, Chinese, Simplified Chinese, Tagalog, Portuguese, Vietnamese, Japanese, English, Malaysian

■How to use

①Access the Multilingual Pre vaccination Screening Questionnaire tool from the following link:

②Select your favourite language

③Fill in the first part of the Questionnaire with your personal information and click “NEXT”

④Fill in the second part of the Questionnaire, replying to the questions and click “NEXT”.

⑤Check your entries and click “NEXT”.

⑥Give it a final check and click “Print Out”

➆You will see a Questionnaire filled in Japanese according to your entires. You can print it out and bring it with you at the Vaccination venue, OR you can copy the Japanese text by hand onto your original hardcopy Questionnaire. 

※You can input your information in English and/or Japanese ONLY
※Please write down your body temperature at the time you arrive at the vaccination venue
※If you have questions in regards to the Questionnaire, please ask the doctor during the consultation 
※Both the patient and the patient’s guardian (if any) will have to sign the Questionnaire, signing with a pen.

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