File name: Vaccination Consent Form Pdf
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BBB A+ Rated Business · Free Trial · 3M+ Satisfied CustomersService catalog: Document Management, Electronic Signatures, Cloud Storage. If you choose to have the COVID Vaccine today, continue to follow all current guidance to protect yourself, including wearing a mask, social distancing, and washing your hands . I consent to receiving/for my child to receive, the vaccine listed below. I will stay in the pharmacy for at least 15 minutes after the injection and seek medical attention if needed. I will report any . Walgreens will send vaccination information from this visit to your doctor/primary care provider using the contact information provided below. SECTION B The following questions will help us determine your eligibility to be vaccinated today. Do you feel sick today? Do you have any health conditions, such as heart disease, diabetes or asthma? 3. Walgreens will send vaccination information from this visit to your doctor/primary care provider using the contact information provided below. Doctor/primary care provider name: Address: The following questions will help us determine your eligibility to be vaccinated today. 1. Do you feel sick today?. The vaccine continues to be available under an EUA for certain populations, including for those individuals 5 through 15 years of age and for the administration of a third dose in the populations set forth in the consent section below.
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