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Publix vaccine form 2026

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The document is an Immunization Consent Form used by Publix Super Markets, Inc. It collects personal and medical information from individuals seeking vaccination, including age, health history, and potential allergies. The form includes a series of questions to assess precautions and contraindications for vaccination. It also contains acknowledgments regarding the understanding of vaccine information, privacy practices, and liability waivers. By signing the form, individuals consent to receive the vaccine and authorize Publix to handle insurance claims related to the vaccination.

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Click ‘Get Form’ to open the Publix vaccine form in the editor.
Begin by filling in your personal information, including your name, birth date, age, and Medicare ID number. Ensure all details are accurate for proper processing.
Provide your address, phone number, and emergency contact information. This is crucial for any follow-up communication regarding your vaccination.
Indicate whether you are a Publix associate by entering your personnel number if applicable.
Answer the precautions and contraindications questions by marking 'YES' or 'NO'. If you answer 'YES' to any question, consult with a pharmacist before proceeding.
Read through the acknowledgments section carefully. Initial each statement to confirm your understanding and agreement.
Sign and date the form at the bottom to certify that all information provided is true and complete.

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Versions	Form popularity	Fillable & printable
2021	4.3 Satisfied (27 Votes)
2018	4.4 Satisfied (20 Votes)
2014	4 Satisfied (39 Votes)
2012	4.8 Satisfied (81 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How much does the flu shot typically cost?

Without insurance, typical prices for older adult flu vaccines range between $50 and $75 , depending on the vaccine type. You can ask your doctor about getting the flu shot during an office visit. Some pharmacies and hospitals in your community may provide vaccinations.

Is it free to get vaccines at CVS?

The COVID-19 vaccine is available at no cost through most insurance plans, including Medicare Part B. CVS Pharmacy and MinuteClinic can directly bill many national and regional health plans that cover all or part of the cost of a flu shot. Check with your health insurance provider to confirm coverage.

What kind of flu shot does Publix give?

With the health of our communities as a top priority, we are proud to offer immunizations as part of our pharmacy services. Publix Pharmacy will offer both the Fluad, recommended for patients age 65 and older, and the Flucelvax for patients age 64 and younger. Both vaccinations protect against influenza A and B.

Does Publix give $10 gift card for flu shot?

💉 Our patients are already taking advantage of this amazing offer, and now its your turn! Protect your health with a free flu shot and receive a FREE $10 Publix gift card when you do! Walk-ins are welcome, so stop by today and take care of your health!

What is a flu vaccine voucher?

Flu Vouchers are a great solution that allow you to offer the flu shot to staff members who are unavailable for an onsite program, utilising a 2,100 plus Australia and New Zealand wide network of Pharmacy locations. Vouchers can be used on their own or in conjunction with an. onsite flu vaccination program.

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How do I get a free flu vaccine?

From 1 September 2025, you can get a flu vaccine from your GP surgery or your maternity service (if your maternity service offers the flu vaccine). From 1 October 2025, you can also get vaccinated at a pharmacy that offers free flu vaccination if youre aged 18 or over. Its best to get vaccinated as soon as you can.

What brand of COVID vaccine does Publix use?

LAKELAND, Fla., May 2, 2023 Following the Food and Drug Administrations recent decision to simplify COVID-19 vaccine guidance, Publix Pharmacy will continue to provide Moderna and Pfizer updated vaccines for eligible individuals.