IMPORTANT REMINDERS

ANYONE UNDER 18 MUST HAVE A PARENT OR GUARDIAN WITH THEM TO SIGN CONSENT.

No Government issued ID or insurance required.

Must have started vaccination series on or after September 4 to be eligible for second-dose incentive.

Vaccine EUA

Patient acknowledges that they are receiving a vaccination that is currently covered under Emergency Use Authorization, and has reviewed the Pfizer-BioNTech EUA or Janssen EUA provided by the FDA for the vaccine that they are receiving.


[If patient is receiving an influenza vaccine]: Patient acknowledges that they are receiving an influenza vaccination and has reviewed the Influenza Vaccine Information Statement.