Get Wegmans Pharmacy Informed Consent/screening Questionnaire To Receive Inactivated Injectable

Filling out the Wegmans Pharmacy Informed Consent/Screening Questionnaire is an important step to ensure your vaccination process goes smoothly. This guide provides clear, step-by-step instructions on how to complete the form accurately and thoroughly.

Follow the steps to seamlessly complete the informed consent and screening questionnaire.

1. Press the ‘Get Form’ button to download the Wegmans Pharmacy Informed Consent/Screening Questionnaire for online completion.
2. Begin by entering your name as it appears on your identification. Provide your date of birth in the specified format (mm/dd/yy) and your age in years.
3. Indicate your gender by selecting the appropriate option available on the form. Then, provide your local phone number where you can be reached.
4. Fill in your local address, including city, state, and ZIP code. Ensure all fields are filled accurately to avoid any issues.
5. List any known allergies in the space provided. This includes allergies to medications, food, vaccine components, or latex.
6. If you are not a student, provide the name and address of your primary care physician. If you are a student, list the relevant information as per the options provided.
7. Check the box that best describes your status: Faculty, Staff, Student, or Other. Fill in your Cornell ID or Net ID if applicable.
8. Answer the screening questions truthfully. If you answer 'Yes' to any question, remember it does not automatically disqualify you but may require additional inquiry from the pharmacist.
9. Review the consent section, ensuring you understand the vaccine information and any associated risks. Sign to consent to the administration of the vaccine(s) and confirm your understanding of the vaccine's benefits.
10. Complete any additional information required, such as your signature, relationship to the patient (if you are signing on their behalf), and date.
11. Once all fields are completed, you may save the changes, download, print, or share the form as needed for your vaccination process.

Begin the process now by filling out your Wegmans Pharmacy Informed Consent/Screening Questionnaire online.