Consent release influenza vaccine: Fill out & sign online

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Click ‘Get Form’ to open the consent release influenza vaccine document in the editor.
Begin by filling out the 'Participant Information' section. Enter your company name, location, first and last name, address, city, phone number, email, date of birth, and zip code.
Proceed to the 'Vaccine Eligibility' section. Answer each question regarding your vaccination history and allergies. If applicable, provide explanations for any 'yes' responses.
In the 'Consent' section, read through the statements carefully. Confirm your understanding by signing and dating the form at the designated fields.
For healthcare provider use only: Ensure that clinic number, manufacturer/product details, lot number, expiration date, and injection site are filled out by the nurse administering the vaccine.

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Do you need informed consent for vaccines?

I acknowledge that I have read this document in its entirety and fully understand it. Despite these facts, I have decided to decline the influenza vaccine by my signature below. I realize that I may re-address this issue at any time and accept vaccination in the future.

How do you write a flu declination letter?

There is no Federal requirement for informed consent relating to immunization. For state and local regulations, check with your local or state health department.

Do you need consent for the flu vaccine?

Federal law does not require signed consent in order for a person to be vaccinated. Signed consent is not required by federal law for vaccination (although some states may require it).