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Tdap (Tetanus, Diphtheria, Pertussis) Immunization - UMPA 2026

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  1. Click ‘Get Form’ to open the Tdap Immunization Consent Form in the editor.
  2. Begin by entering the recipient's first and last name in the designated field. Ensure accuracy for proper identification.
  3. Next, input the birth date in the format provided (MM/DD/YYYY). This is crucial for age verification.
  4. Proceed to answer each question by circling YES or NO. If you have any uncertainties, feel free to ask for assistance.
  5. Review the section regarding individuals who should not be vaccinated. Make sure to check if any of these apply to you.
  6. In the consent section, initial where indicated after reading the Vaccine Information Statement (VIS) and understanding the risks and benefits.
  7. Finally, sign and date the form at the bottom. Ensure that all information is complete before submission.

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