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DRAFT CONSENT FOR TREATMENT

DRAFT CONSENT FOR TREATMENT 2026

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The document is a consent form for influenza immunization provided by GetAFluShot (GAFS), detailing the patient's acknowledgment of potential adverse reactions, insurance information, and liability release. It emphasizes the patient's responsibility for any reactions and the requirement to stay on-site for 15 minutes post-vaccination.

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Click ‘Get Form’ to open the DRAFT CONSENT FOR TREATMENT in the editor.
Begin by entering your primary and secondary insurance information in the designated fields. This ensures that all necessary billing details are captured.
Indicate whether you are feeling sick today by selecting 'Yes' or 'No'. This is important for assessing eligibility for the immunization.
Read through the section regarding adverse reactions associated with the influenza vaccine. Acknowledge that you have had the opportunity to ask questions and have received a copy of the Vaccine Information Statement (VIS).
Sign and date the form at the bottom, confirming your understanding and agreement to the terms outlined, including your responsibility for any potential costs if insurance coverage is not active.

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