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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: Only register for an appointment if you can attend. At this time, we are unable to reopen cancelled appointments to other patients online. Due to limited vaccine supply, we are currently not allowing individuals to sign up for multiple appointments that are scheduled within 5 days of each other; any additional appointments attempted to be made 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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