The Shot Nurse Download Forms

Forms Download

The forms below are listed by vaccine or service.

Provided is our HIPAA Privacy Policy about protecting your information and how the information may be used as regulated by Omnibus rule.

Print and fill out the Consent form and Authorization form prior to your visit.

Please review the VIS (vaccine information statement) for important information about the vaccine.

Vaccine/Service	Consent Form	Insurance Authorization form	VIS
Flu 2020	Flu Consent Form	Insurance Authorization form	Flu VIS FluMist VIS
Mumps, Measles, and Rubella (MMR)	MMR Consent Form	Insurance Authorization form	MMR VIS
Tetanus, Diphtheria, Pertussis (Tdap)	Tdap Consent Form	Insurance Authorization form	Tdap VIS
Varicella	Varicella Consent Form	Insurance Authorization form	Varicella VIS
Yellow Fever	Yellow Fever Consent Form		Yellow Fever VIS
Pneumococcal (23 and 13)	Pneumococcal (23 and 13) Consent Form	Insurance Authorization form	Pneumococcal 13 VIS Pneumococcal 23 VIS
Shingles	Shingles Consent Form	Insurance Authorization form	Shingles VIS
Tuberculosis Skin Test	Tuberculosis Skin Test Consent Form
Blood Test	Blood Test Consent form