Walmart vaccine consent form 2026

1. Click ‘Get Form’ to open the Walmart Vaccine Consent Form in our editor.
2. Begin by filling out Section A. Clearly print your first name, last name, gender, race/ethnicity, date of birth, and mother's maiden name. Provide your home address, city, state, zip code, and phone number.
3. Indicate whether you have a Primary Care Provider by selecting 'YES' or 'NO', and if applicable, provide their name and address.
4. In Section B, answer the eligibility questions regarding your health status. Be honest about any allergies or chronic conditions that may affect vaccination.
5. Read through Section C carefully. Sign and date to acknowledge your understanding of the vaccine's benefits and risks.
6. If you are a healthcare provider completing Section D, ensure all required fields are filled accurately before submitting the form.

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