Vaccination Consent Form

Save time! Print and complete your vaccination consent form and bring it to the pharmacy!

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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

 

alertA Note from Northwest Pharmacy

Prior to vaccines being administered, we require you to complete our Vaccination Consent Form. You can fill this form out at the pharmacy or, to save time, you can print the form, fill it out at home and bring it in with you.

If you choose to download and sign our Vaccination Consent Form – you agree to review the current Vaccine Information Statement (VIS) for the intended vaccine and understand the benefits/risk of intended vaccine before signing. Our pharmacists will gladly answer any questions you have when you come in for your vaccination.

View Current VISs for vaccines offered by Northwest Pharmacy HERE

Get our Vaccination Consent Form HERE  (You will need Adobe Acrobat Reader to view this form. The program is free and can be downloaded at http://www.adobe.com)