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)