If you are vaccinating an Atrium Health teammate, please use this Vaccine Immunization Consent Form.
You provided verbal consent to receive vaccines and were able to ask questions about the vaccine.
Vaccine Information Sheets (Influenza and COVID-19) have been provided to you and you have had a chance to ask questions which were answered to your satisfaction. To the best of your knowledge, you have no contraindications to the vaccine(s). You understand the benefits and risks of vaccine(s).