Before receiving any vaccine, Northwest Pharmacy requires completion of our Vaccination Consent Form. You can fill out this form when you visit the pharmacy, or for your convenience, click the image below to download, print, and complete the form ahead of time to bring with you.

By downloading and signing the Vaccination Consent Form, you acknowledge that you’ve reviewed the current Vaccine Information Statement (VIS) for your intended vaccine and that you understand the benefits and risks before signing.

Our pharmacists are always happy to answer any questions and discuss your vaccine options when you come in.

Vaccination Consent Form

*You will need Adobe Acrobat Reader to open/view/print this form. The program is free and can be downloaded at http://www.adobe.com