Get The Flu Shot Consent Form - Salem Academy

Filling out the flu shot consent form is an essential step for those planning to receive the influenza vaccine at Salem Academy. This guide will walk you through each section of the online form, ensuring a smooth and efficient process.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the flu shot consent form and open it in your preferred document editor.
2. Begin with the first section, where you will input your personal information. Clearly print your full name as it appears on your employee records if you are employed; otherwise, use your complete first, middle, and last names.
3. Next, fill in your address, including city, state, and zip code, along with your day phone number.
4. Provide your date of birth in the format mm/dd/yyyy and indicate your gender by selecting the appropriate option.
5. Input your email address for communication regarding your vaccination.
6. Proceed to assess your medical history concerning contraindications. Answer the questions regarding allergies and previous reactions, making sure to select 'Yes' or 'No' as appropriate for each inquiry.
7. If applicable, you must answer additional questions regarding your pregnancy status and any allergies, ensuring to provide accurate information.
8. Acknowledge understanding of the side effects and adverse reactions associated with the vaccine by reviewing the provided information. Ensure you are aware of the related documents you might need.
9. Sign and date the form to confirm your request for immunization, understanding the associated risks and responsibilities.
10. Finally, save any changes made to the form. You may choose to download, print, or share the completed form as needed.

Complete the flu shot consent form online today to secure your vaccination.