Get Vaccine Consent & Assessment - Aps.edu

Filling out the VACCINE CONSENT & ASSESSMENT form is an important step in ensuring your vaccination process is safe and effective. This guide will walk you through each section of the form, providing clear instructions for completing it online.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the VACCINE CONSENT & ASSESSMENT form and open it for editing.
2. Begin by entering your personal details. Fill in your first name, middle initial, last name, date of birth, age, weight, gender, ethnicity, home address, city, state, and ZIP code in the corresponding fields.
3. Provide your home phone number and details of your primary care provider, including their name, address, and phone number.
4. Enter your insurance carrier information, including your cardholder ID and group number.
5. In the section labeled 'I want to be protected from the following,' check all applicable vaccines you wish to receive.
6. Respond to the safety assessment questions. For each question, choose 'Yes' or 'No' and provide any necessary details, especially for allergies or previous vaccine reactions.
7. Review the consent statement carefully. If you agree, provide your signature and the date at the bottom of the form. If the patient is under 18, a legal guardian must sign.
8. Finally, ensure all information is accurate and complete. You can then save changes to the form, download it, print it, or share it as necessary.

Complete your VACCINE CONSENT & ASSESSMENT form online for a smooth vaccination experience.