Vaccine administration consent form 2025

1. Click ‘Get Form’ to open the vaccine administration consent form in the editor.
2. Begin by filling out Section A. Clearly print your first and last name, home address, and date of birth. Ensure you select your race and gender from the provided options.
3. Provide your phone number and indicate whether you have a primary care physician. If yes, include their name and address.
4. In the vaccine requested section, check all applicable vaccines you wish to receive.
5. Proceed to Section B, answering all eligibility questions truthfully. Initial next to each question after discussing with the pharmacist.
6. Read Section C carefully before signing. This section confirms your understanding of the vaccination process and consent for information sharing.
7. Finally, ensure that a healthcare provider completes Section D after administering the vaccine.

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