Information Regarding Recommended Hepatitis B and Tuberculosis Vaccinations "*" indicates required fields I understand that due to my occupational exposure to blood or other potentially infectious materials, I may be at risk of exposure to Hepatitis B and/or Tuberculosis. Behavior Intervention Services strongly recommends and has provided the opportunity for vaccination against Hep-B and TB by providing a reimbursement for each test. I understand that I can either choose to receive these vaccinations on my own time and through my own appointments and that once completed and read, I may turn in those results and receipts to the Financial Department for reimbursement. Hepatitis B: up to $24 PPD (Tuberculosis): up to $120 I understand that, unless I have had a previous vaccination against Hepatitis B or TB, I may be at risk of acquiring these illnesses. Name* First Last Email* Currently Vaccinated I will check the box here if I am currently vaccinated.Signature*HiddenDate* MM slash DD slash YYYY