Publix Pharmacy Virginia Immunization Consent Form 2026

See details

4.3 out of 5

27 votes

The document is an Immunization Consent Form used by Publix for patients to authorize the administration of vaccines. It collects personal information, vaccine preferences, and medical history to assess eligibility and potential risks. The form includes a series of questions regarding health conditions and allergies that may affect vaccination. By signing, the consent-giver acknowledges understanding the associated risks and benefits, authorizes insurance claims, and releases Publix from liability related to vaccine administration.

Here's how it works

01. Edit your publix immunization online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send pharmacy immunization consent form via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Publix Pharmacy Virginia Immunization Consent Form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Publix Pharmacy Virginia Immunization Consent Form in the editor.
Begin by entering the patient's name, birth date, age, and sex in the designated fields. Ensure accuracy as this information is crucial for identification.
Fill in the address, city, state, zip code, and phone number. This helps in maintaining proper communication regarding vaccination details.
Provide the Medicare ID number if applicable and include any relevant personnel number for Publix associates.
Select the vaccines that the patient wishes to receive today by checking all applicable boxes. Be aware of any state restrictions that may apply.
Answer the precautions and contraindications questions by marking YES or NO. If you answer YES to any question from 2 to 14, consult with your pharmacist before proceeding.
Review the consent section carefully. Ensure that you understand all risks and benefits associated with the vaccine before signing.
Finally, sign and date the form at the bottom. If you are a guardian, indicate your relation to the patient.

Start using our platform today for free to complete your immunization consent form effortlessly!

See more Publix Pharmacy Virginia Immunization Consent Form versions

We've got more versions of the Publix Pharmacy Virginia Immunization Consent Form form. Select the right Publix Pharmacy Virginia Immunization Consent Form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2021	4.3 Satisfied (27 Votes)
2018	4.4 Satisfied (20 Votes)
2014	4 Satisfied (39 Votes)
2012	4.8 Satisfied (81 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

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.

What do I need to sign my publix immunization form electronically?

Electronic document signing requires a software solution that works in compliance with data security and eSignature laws. DocHub is an excellent tool for that, because it fulfills all the aforementioned requirements. Whatever method you prefer to sign your publix immunization form in DocHub, your electronic signature will be legally binding and court-admissible.

How do you fill out publix immunization consent form on Android?

It is a no-brainer on a computer or via a mobile phone to complete a publix immunization consent form with DocHub. All you need to do is open any installed internet browser on your smartphone and go to the DocHub site. Once authenticated, add your document and open it in editing mode. Use our toolbar to make your edits and save modifications. Optionally, keep your document in your files or send it to a recipient immediately.

How to obtain immunization records in Virginia?

LAKELAND, Fla., May 2, 2023 Following the Food and Drug Administrations recent decision to simplify COVID-19 vaccine guidance, Publix Pharmacy will continue to provide Moderna and Pfizer updated vaccines for eligible individuals.

Do you need informed consent for vaccines?

There is no Federal requirement for informed consent relating to immunization. For state and local regulations, check with your local or state health department.

Is consent required for vaccines?

Virginia residents can access their immunization records through confidential, HIPAA-compliant VDH portals on a computer or mobile device. Simply visit the appropriate portal (MyIR, MMR, or COVID-19) and follow the instructions to verify your identity and access your records.

publix pharmacy immunization consent

Change Publix vaccine appointment How much is a flu shot at Publix without insurance Cancel Publix vaccine appointment Immunization Consent Form PDF Publix Pharmacy vaccines Publix flu shot $10 Publix vaccine booster appointment Printable vaccine Consent form

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

Can you be vaccinated without your consent?

All vaccines administered should be fully documented in the patients permanent medical record. Health care providers who administer vaccines that are covered by the National Vaccine Injury Compensation Program are required by law to ensure the permanent medical record of the recipient indicates: Date of administration.

Publix Pharmacy Virginia Immunization Consent Form 2026

Here's how it works

How to use or fill out Publix Pharmacy Virginia Immunization Consent Form with our platform

See more Publix Pharmacy Virginia Immunization Consent Form versions

Complete this form in 5 minutes or less

Got questions?

What do I need to sign my publix immunization form electronically?

How do you fill out publix immunization consent form on Android?

How to obtain immunization records in Virginia?

Do you need informed consent for vaccines?

Is consent required for vaccines?

Complete this form in 5 minutes or less

People also ask

Can you be vaccinated without your consent?

publix pharmacy immunization consent form

Try more PDF tools