This two-sided form provides either employees or residents/patients with general information to help make an informed decision about COVID-19 vaccinations.

The information surrounding COVID-19 vaccinations is constantly changing. This form is current as of its design in November 2021. To accommodate for upcoming changes, a checkbox is included which states: The most up-to-date fact sheets from each vaccination is available online. The most recent version has been made available to me either digitally or in print. 


For a full-sized PDF, click here.


To purchase this form, click here or give us a call at 800-438-8884.