NYS FORMS
COVID-19

COVID-19 CONSENT FORM

(NEEDED BEFORE YOU HAVE AN APPOINTMENT)

Please click the button below to download and fill out the COVID-19 Consent Form.  This form is required by the state of New York to receive a COVID-19 vaccination and must be provided to our staff prior to your appointment.

Download Adult Form

(Ages 12 Years and Older)

Download Child Form

(Ages 5 - 11 Years Old)

 
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