Filling out the Costco pharmacy vaccine consent form is quick and straightforward with our online PDF editor. The entire process takes under five minutes. Follow these four steps to complete, download, and use your form before your vaccination appointment.
Step 1: Click the "Get Form Here" button at the top of this page. The PDF opens directly in your browser with no software download or installation required.
Step 2: Use the editing toolbar to type into each field. Click any blank space on the form to place your cursor and begin typing. The toolbar lets you add text, check boxes, insert a date, and draw or upload your signature. Work through the form top to bottom: start with your personal information, then answer the health screening questions, then add your signature in the consent section.
Fill in each of the following required fields:
- Full legal name and date of birth
- Home address and phone number
- Primary healthcare provider name and contact
- Medicare or Medicaid ID number (if applicable)
- Yes or No answers to each health screening question
- Your signature and the date in the consent section
The lower administrative section of the form is for Costco pharmacy staff only. Leave these fields blank when you fill out the form yourself. Pharmacy staff will enter the vaccine lot number, expiration date, injection site, VIS version date, vaccine manufacturer, dosage, route of administration, and payment information after your shot is given.
Step 3: Click "Done" when you have finished filling out all patient sections. You can then download the completed form as a PDF, print it directly from your browser, or send it to your email address for safekeeping.
Step 4: Print one copy to bring to the pharmacy and keep a second copy for your personal health records. Your data is not stored or shared by our platform after you close the session. Each editing session is private and independent.
Tips for Completing the Form Without Errors
Check your date of birth and Medicare ID before you print. Errors in these fields can slow down your check-in at the pharmacy counter and may require you to fill out a new form. If a screening question asks about a condition you are not certain about, answer yes and discuss it with the pharmacist. The pharmacist will determine whether vaccination is safe to proceed.
Print in color when possible. The checkboxes and signature lines are easier to verify in the original formatting. If you are completing this form on behalf of a minor child, the parent or legal guardian must sign the consent section. The pharmacist may ask to see the guardian's photo ID at the counter.
Plan your visit for non-peak times when possible. Costco pharmacies tend to be busiest on weekday mornings and during September and October when flu shot demand peaks. Bringing a pre-filled form reduces your wait time at the counter significantly.
Frequently Asked Questions About the Costco Pharmacy Consent Form
Can I fill out this form at home and bring it to the pharmacy?
Yes. Costco pharmacies accept pre-completed consent forms. Filling it out at home and printing it before your visit reduces wait time at the counter, which is especially helpful during busy flu season in fall.
How many pages is the form?
The standard form is one page. Both the patient consent section and the pharmacy administrative record section fit on a single sheet.
Do I need a new form for each vaccine visit?
Yes. A separate consent form is completed for each visit. The pharmacist records the vaccine lot number, date, and injection details specific to that appointment. You cannot reuse a form from a previous visit.
Is there a cost to download or fill out this form?
No. The PDF is free to access, complete, and print from this page.
What should I bring to my Costco pharmacy vaccine appointment?
Bring your completed consent form, your insurance card, your Medicare or Medicaid card if applicable, and a photo ID. Wearing a short-sleeved shirt makes it easier for the pharmacist to administer the injection.
Related Pharmacy and Health Forms
If you are managing your immunization records or need other pharmacy documents, these related forms may be helpful:
- Adult Immunization Record - keep a complete log of all your vaccines in one document
- Aetna Pharmacy Prior Authorization Form - required when your insurance plan needs pre-approval for a vaccine
- Pharmacy Prior Authorization Form - general template for pharmacy pre-authorization requests
