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Covid-19 Vaccine Informed Consent

YOU MUST:

  • Answer all the questions and complete every section of the consent form.
  • Submit one form for each patient.

If any of the following questions are not clear, please ask your health care provider for assistance.

NOTE: We are currently not allowing individuals to sign up for multiple appointments that are made within 5 days of each other; any additional appointments attempted to be made within that timeframe will be blocked.

TIME TO COMPLETE:

5-10 minutes.

TIME TO PROCESS:

15-20 minutes.

Documents to Upload:

Please have your insurance card and Medicare Part B red, white, blue card (if Medicare recipient) ready to upload. Uninsured individuals can still receive the vaccine at no cost.

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