Costco flu shot 2026

1. Click ‘Get Form’ to open the Costco Flu Shot Immunization Consent Form in our editor.
2. Begin by entering the patient's last name, first name, and middle initial in the designated fields. Ensure accuracy for proper identification.
3. Fill in the address, city, state, zip code, and a 10-digit phone number. This information is crucial for contact purposes.
4. Provide the Medicare ID number and birth date in the specified format (MM/DD/YYYY) to verify eligibility.
5. Complete the primary healthcare prescriber section by entering their name, address, and phone/fax number.
6. Indicate the vaccine requested and check 'yes' or 'no' for each precaution and contraindication question to assess health risks.
7. Review the adverse reactions section carefully. Acknowledge understanding by signing at the bottom of the form.

Start filling out your Costco Flu Shot form online for free today!