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Publix vaccine consent form

Publix covid vaccine form 2026

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The document is an Immunization Consent Form used by Publix Super Markets, Inc. It collects personal information from the patient, assesses medical history and potential contraindications for vaccination, and includes acknowledgments regarding the vaccine's information and privacy practices. The form also contains sections for authorization of insurance benefits, a waiver of liability, and a record of vaccine administration. Patients must confirm their understanding and agreement by signing the form.

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Click ‘Get Form’ to open the Publix COVID vaccine form in the editor.
Begin by filling in your personal information, including your name, birth date, age, sex, address, and phone number. Ensure all details are accurate for proper identification.
Next, answer the questions regarding precautions and contraindications by marking 'YES' or 'NO' for each item. If you have any allergies or medical conditions listed, be sure to provide additional details where required.
In the acknowledgments section, indicate your consent for vaccination by specifying the vaccine type you wish to receive. Review the statements carefully before signing.
Complete the authorization for assignment of benefits and release of medical information if applicable. This allows Publix to process any insurance claims on your behalf.
Finally, sign and date the form at the bottom. Ensure that you print your name clearly as well.

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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.

When will the COVID vaccine be available in 2025?

If youre eligible for the winter COVID-19 vaccine and are aged 5 years or over, you can book a COVID-19 vaccination appointment online or in the NHS App now. Vaccination appointments will take place from 1 October 2025. From 1 October 2025, you may also be able to get vaccinated at: a walk-in COVID-19 vaccination site.

Will there be a flu vaccine in 2025?

In March 2025, the FDA approved Flublok, the recombinant influenza vaccine, previously approved for ages 18 years, for ages 9 years. There are different flu vaccines. The decision is yours. Ask your healthcare provider about available flu vaccine options.

How long does it take for a vaccine to become available?

Vaccine development often takes 10-15 years of laboratory research, usually at a company in private industry, but often involves collaboration with researchers at a university.

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!

Do you still need the COVID vaccine in 2025?

Spring 2025 vaccine eligibility COVID-19 is more serious in older people and in people with certain underlying health conditions. For these reasons, people aged 75 years and over, those in care homes, and those aged 6 months and over with a weakened immune system are being offered a spring dose of COVID-19 vaccine.

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When is the best time to get a COVID booster?

The optimal timing for COVID-19 booster administration is highly location-specific but generally falls in early autumn for the Northern Hemisphere. Administering boosters in September or October can provide up to three to four times more protection against infection compared to booster shots given later in the year.