CONSENT FOR VACCINATION(S) - YOU MUST SIGN HERE FOR YOU/YOUR FAMILY TO BE VACCINATED
Health care services are confidential. No information is released without your consent except as may be required under public health and safety laws. Information used for evaluation and planning purposes never includes personal identifiers. To access a copy of Beacon's notice of privacy practices please request from Beacon by sending email to info@beaconohss.com.
By Completing this form, I am acknowledging:
- The information provided is correct
- I have read the EUA fact sheet provided
- I understand the risks and benefits of getting the vaccine(s) and consent for me and my family to be vaccinated
- Any questions I had about the vaccine(s) have been answered