Get Madison Pharmacy Shingrix (shingles) Immunization Consent Form 2020-2026

Completing the Madison Pharmacy Shingrix Immunization Consent Form online is a straightforward process. This guide will provide you with clear instructions to ensure that you fill out each section accurately and efficiently.

Follow the steps to fill out your consent form correctly.

1. Click ‘Get Form’ button to access the consent form and open it for editing.
2. Begin by entering your personal information in the designated fields. This includes your full name, date of birth, age, and gender. Ensure all information is accurate and up to date.
3. Provide your address, including city, state, and zip code, along with your phone number. This will help the pharmacy contact you if needed.
4. Enter your primary doctor's name and phone number. This is to establish communication concerning your immunization.
5. Indicate which vaccine(s) you would like to receive by selecting the appropriate options.
6. If you weigh less than 130 pounds, enter your weight in the specified field.
7. Answer the health screening questions honestly. These questions will help determine your eligibility for vaccination. If unclear about any question, consult with your healthcare provider.
8. Review the section regarding adverse reactions and confirm that you understand the risks involved with the vaccination by checking the box or initialing as needed.
9. Sign and date the form in the designated areas. If you are a legal guardian completing the form for someone else, ensure the signature reflects that responsibility.
10. Once you have filled out all sections, save your changes. You may choose to download, print, or share the completed form as needed.

Complete your document online today to ensure a smooth immunization process.