Walgreens Vaccination Consent Form

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In 2020, the whole world will find out how dangerous the pandemic can be even in the 21st century. With the COVID-19 disease, many countries began to insist on their citizens’ vaccination, and some countries have tried their best to create various vaccines.

While the importance of vaccination is still discussed, and some people make it a huge question, still, there is a common opinion that vaccination can make the disease and its consequences easier, and many patients have already proven it. So, we recommend you think about getting your anti-COVID shot if you have not done it yet.

This form is a document that proves your consent to the upcoming vaccination and tells the doctor the most important details about your health and wellbeing. Without signing such a paper, you will not be able to complete your vaccination.

The form includes your personal details and answers to various questions about your health state. You may fill out the template before visiting Walgreens or complete it there. However, if you want to get prepared in advance and spend less time at the store, we advise you to use our form-building software or the Walgreens official site to get the form and complete it.

Below, you will find out what vaccines are available at the store, how to make an appointment, and how to fill out the template properly.

What Vaccines Are Available at Walgreens?

Right now, you may receive one of three vaccines at the store. They are manufactured by Pfizer, Moderna, and Johnson & Johnson. They have different working principles and features.

Pfizer and Moderna are two-shot vaccines with booster shots available, and Johnson & Johnson is only a one-shot vaccine. We recommend you to read about all options online before you decide which vaccine you want to get; also, it is advisable to talk to your physician who knows your health history well and may recommend this or that shot for a certain reason.

How to Schedule My Vaccination at Walgreens?

Scheduling your vaccination appointment at Walgreens is effortless: you shall only have a connection to the internet and a device that will help you (your smartphone, laptop, or tablet). Besides, it is possible to call your local pharmacy and schedule your shot.

Use the Walgreens official site to schedule your vaccination. You can also reach the vaccination appointment scheduling via mobile apps.

On this same page, you will also get plenty of useful details and videos about the vaccines and questions that bother a lot of patients. The information placed on this website will also help you to feel less scared about the COVID-19 vaccination if you are. Do not hesitate to watch videos and read the FAQs section if you need to know more.

When you have scheduled your vaccination appointment at Walgreens, you can fill out and sign the consent form in advance and make yourself fully prepared for the procedure. Below, you will find a set of brief but clear instructions that will explain to you how to complete the template properly.

Filling Out the Template

You will have to answer a long list of personal questions about your health. Please be honest so that the medical personnel gets the correct information about you.

Before you proceed to all the “filling out” instructions, do not forget that you shall obtain the correct Walgreens Vaccination Consent template first. Our form-building software was released specifically for your convenience, and making various documents has never been easier. Generate the form using our software and proceed to our guidelines below.

Step 1. Provide Personal Details in Section A

Section A of the form is fully dedicated to your details so the medical personnel can easily identify you. Step by step, enter the following information about yourself:

  • First and last name
  • Birthdate, age, and gender
  • Phone number
  • Home address (including postal code, city, and state)
  • Email address.

Mark the relevant box if you wish to receive any notifications regarding this form and your prescription updates.

Then, mark the boxes that describe your race and ethnicity. Provide the details about your doctor or primary care provider: their name, phone number, and full address.

After you have provided all the demanded details, specify the vaccination (or vaccinations) you would like to receive. This will be the end of Section A.
Step 1 to filling out a walgreens vaccination consent form - personal details

Step 2. Answer the Questions Regarding Your Health State

The form’s following part, Section B, offers 19 questions about your health conditions. You will have three options as answers: “yes,” “no,” or “don’t know.”

Among the topics are COVID-19 testing, allergic reactions to different medications, reactions to vaccinations you had before, chronic health conditions, and so on.

Read each question carefully and answer all of them honestly. This will help the medical staff understand whether you can get the vaccine or if there are reasons to decline your application or postpone your vaccination.
Step 2 to filling out a walgreens vaccination consent template - health state

Step 3. Read All the Conditions of Section C Carefully

After you have answered all the questions below, you will see Section C with some conditions and terms you shall read and accept before signing this form. You have to provide only truthful information about yourself in this form, so the conditions you read should also be suitable for you.
Step 3 to filling out a walgreens vaccination consent sample - conditions

Step 4. Sign the Form

If you read all the terms and agree with them, you may sign the form to prove your consent to the vaccination. Next to your signature, do not forget to put the current date.
Step 4 to filling out a walgreens vaccination consent sample - signature

Step 5. Add Details about Your Insurance

Section D you will see below must be filled out only by an insurance patient or authorized person.

Here, you shall enter information about pharmacy and medical cards, your Medicare number, and other insurance items.

For the COVID-19 vaccination at Walgreens, you do not need medical or pharmacy insurance. You shall provide only your state ID number or driving license number.
Step 5 to filling out a walgreens vaccination consent example - insurance details

Step 6. Pass the Document to Your Healthcare Provider

Sections E, F, and G of this template should be completed by your healthcare provider. So, after you have filled out everything that was above, you shall pass the form to them to finalize.

The healthcare provider will confirm that they have read your information and that the vaccination doze you will get has a proper expiration date and other characteristics. They will also mark some points that describe their interaction with you as a patient.

Then, after you get a shot, they will add everything about the doze in the specific chart placed in Section G.

After all the form’s sections are filled out, the healthcare provider will sign the form and date it. If they or you need to leave some notes regarding the form or vaccination procedure, there are a couple of empty lines below the template’s Section G.