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COVID-19 vaccine is available at CVS! Schedule a flu vaccine appointment today at a CVS Pharmacy near you. No cost with most insurance. Restrictions apply.
- Flu Shots
The updated COVID-19 vaccine is now available at your nearby...
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- COVID-19 vaccination consent form for adults who are able to consent (open source version)
- COVID-19 vaccination consent form for adults who are able to consent (MS Word version)
- COVID-19 vaccination consent form for adults who are able to consent (PDF version)
- COVID-19 vaccination consent form letter for adults who are able to consent (open source version)
- COVID-19 vaccination consent form letter for adults who are able to consent (MS Word version)
- Details
Coronavirus (COVID-19) vaccination consent form and letter templates for adults who are able to consent.
ODT, 28.9 KB
This file is in an OpenDocument format
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MS Word Document, 30.6 KB
This file may not be suitable for users of assistive technology.
Request an accessible format.
If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.
Ref: PHE gateway number 2020376
PDF, 51.1 KB, 1 page
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ODT, 192 KB
This file is in an OpenDocument format
This file may not be suitable for users of assistive technology.
Request an accessible format.
MS Word Document, 205 KB
This file may not be suitable for users of assistive technology.
Request an accessible format.
If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@phe.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.
The coronavirus (COVID-19) vaccination consent form and letter templates are available in different software versions and can be downloaded. The letter templates can be adapted to suit the needs of local healthcare teams.
Copies of the adult consent form (PDF version) are available to order using product code COV2020376V2.
A British Sign Language (BSL) video explaining the COVID-19 vaccination consent form is available to view and download.
Health publications orderline
Immunisation Publications
UK Health Security Agency, 61 Colindale Avenue, Colindale
Find 15+ vaccines like flu, COVID-19, RSV (respiratory syncytial virus), shingles, pneumonia (pneumococcal), hepatitis B and more. Plus, get a $5 off $20 coupon* for the next time you shop at CVS®. Restrictions apply.*. Schedule your vaccinations.
We are now offering FREE COVID vaccines & booster shots. Get protected and schedule an appointment for a COVID vaccine today! Vaccine types and availability vary by location.
Vaccine Administration Record (VAR)—Informed Consent for Vaccination. If the patient is requesting a fu vaccination, indicate the patient’s age group: Under age 65 Age 65 or older. OFF-SITE CLINIC BILLING GROUP: SECTION A Please print clearly. First name: Date of birth: Store number: Rx number: Store address: Age: Gender:
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The vaccine is available at no-cost through most insurance plans. In addition, CVS Pharmacy will be participating in the CDC’s Bridge Access Program. CVS Pharmacy also accepts walk-ins, seven days a week, including during evening and weekend hours.
Because the Pfizer-BioNTech vaccine is the only FDA-authorized COVID-19 vaccine for adolescents in this age group, patients are encouraged to schedule an appointment online at cvs.com or through the CVS Pharmacy app to ensure availability. Walk-ins are also accepted.
