Vaccine Consent Forms

Choose the form based on who will be vaccinated.  Forms can be printed and completed before the appointment, saving time at check-in.

 

  • Vaccine Questionnaire:  Any adult vaccination OR a child accompanied by a parent or legal guardiane. Please bring insurance card.
  • Vaccine Consent for parents:  Children under 18 who will receive vaccine without a parent or legal guardian present.  This includes vaccines at school.
  • Flu/Covid form:  Adults who will get only the flu and/or COVID vaccine OR children accompanied by a parent or legal guardian. Please bring insurance card.
  • Flu/Covid consent for parents  Children under 18 who will receive only flu or COVID vaccine without a parent or legal guardian present.