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UMPA University Medical Practice Associates Tdap (Tetanus, Diphtheria, Pertussis) Immunization Consent Form Recipient First and Last Name (Print): Birth date: / / Please circle YES or NO for each.

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How to fill out the Tdap (Tetanus) immunization consent form online

This guide provides step-by-step instructions for completing the Tdap (Tetanus, Diphtheria, Pertussis) immunization consent form. Ensure you have all necessary information and follow each step thoroughly to complete the form correctly.

Follow the steps to accurately complete your immunization consent form.

  1. Press the ‘Get Form’ button to access the form and open it in your chosen document editing tool.
  2. Begin by entering the recipient's first and last name in the designated field. Ensure the name is printed clearly.
  3. Fill in the recipient's birth date using the specified format: month/day/year.
  4. For each question regarding medical history, circle either YES or NO as applicable. If you are unsure about any question, do not hesitate to seek guidance.
  5. If the recipient is female, answer the pregnancy question honestly by circling YES or NO.
  6. After completing the questions, review any guidelines regarding individuals who should not be vaccinated, ensuring awareness of personal or medical conditions.
  7. Initial next to the statement indicating that you have received and read the Vaccine Information Statement (VIS).
  8. Initial next to the understanding of the risks and benefits of the Tdap vaccination, confirming that all questions have been answered satisfactorily.
  9. Sign the document in the indicated area to validate the consent for services.
  10. Have the administering individual complete the section provided, including their signature and date of administration.
  11. Once all fields are filled, save the changes to your document. You may also download, print, or share the completed form as needed.

Complete your Tdap immunization consent form online today for a smooth and efficient process.

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DTaP (DAPTACEL®, Infanrix®, ®, Pediarix®, ®, Quadracel®, and Vaxelis™) provides protection against diphtheria, tetanus, and whooping cough. Tdap (® and ®) provides protection against tetanus, diphtheria, and whooping cough.

Also, adults should receive a booster dose of either Tdap or Td (a different vaccine that protects against tetanus and diphtheria but not pertussis) every 10 years, or after 5 years in the case of a severe or dirty wound or burn.

Who should get Tdap and Td vaccines? When and how often are these vaccines needed? ALL adults who did not get Tdap vaccine as an adolescent should get one dose of this vaccine. Once they have had this dose, a Td or Tdap booster shot should be given every 10 years.

DTaP contains full doses of diphtheria, tetanus, and whooping cough vaccines. Tdap contains a full dose of the tetanus vaccine and a lower dose of diphtheria and whooping cough vaccines. The lower-case “a” before the “p” in both vaccine names stands for acellular.

What is the difference between Tdap and DTaP? The Tdap and DTaP vaccines help protect against the same diseases but are used for different age groups. Tdap is recommended for older children and adults, and DTaP is recommended for infants and young children.

DTaP is a combination vaccine used to provide immunity against 3 serious diseases (Diphtheria, tetanus, and pertussis [whooping cough]) whereas Tdap is used to boost immunity against the same 3 diseases. Tdap contains a lower dose of vaccine than DTaP.

Tdap vaccine protects against tetanus, diphtheria, and whooping cough (pertussis). Td vaccine protects against tetanus and diphtheria.

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