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Vaccine Consent Form

Please fill out this form and bring to your vaccination appointment. For children under 18 years of age this form must be signed by a parent or guardian and presented at the time of vaccination (parent/guardian may not be present as long as signed consent is received). 

Vaccine Consent 9-6-22 (docx)Download

Emergency Use Authorizations/Vaccine Information Statements

Up to date information for patients and caregivers for vaccines that we offer

Pfizer Covid-19 bivalent 4-18-23 (pdf)Download
Moderna Covid-19 bivalent 4-18-23 (pdf)Download
Flu VIS 8-6-21 (pdf)Download
Meningococcal ACWY VIS 8-6-21 (pdf)Download
Shingrix VIS 2-4-22 (pdf)Download
Tdap VIS 8-6-21 (pdf)Download
MMR VIS 8-6-21 (pdf)Download

Other Documents

Patient Privacy Practices Notice (pdf)Download
COVID vaccine clinic flyer editable PDF (pdf)Download

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