2020 STUDENT HPV VACCINATION CONSENT FORM (Human-2026

1. Click ‘Get Form’ to open it in our editor.
2. Begin by filling in your personal information, including your name, birth date, age, sex, and address. Ensure all details are accurate for proper identification.
3. Provide your contact number and Medicare ID if applicable. If you are a Publix associate, include your personnel number.
4. Carefully review the precautions and contraindications section. Mark 'YES' or 'NO' for each question based on your health status. This is crucial for ensuring safe vaccination.
5. In the consent section, clearly state which vaccine you are consenting to receive. Read through the Vaccine Information Statement provided by Publix before signing.
6. Sign and date the form at the bottom. If you are a guardian signing on behalf of a patient, indicate your relationship.
7. Finally, ensure that any additional information required for billing is completed accurately.

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