18 years of age and older are elegible to receive a vaccine.Every patient will be requested an ID before vaccination. If you have any questions, please call us at (305) 665 4411
Immunization Screaning Questionnaire:
I understand the benefits and risks of the COVID-19 vaccine as described in the Emergency Use Authorization (EUA), a copy of which I will be provided as an attachment with this Consent and Release. I request the vaccine to be given to me or to the person named above, a minor for whom I represent that I am authorized to sign this Consent and Release.
AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION
I hereby voluntarily authorize the disclosure of my protected health information, including any vaccination records, provided by Marco Drugs & Compounding pharmacy to:
Me via email, even though email is not a completely secure means of communication.Me via SMS, even though SMS is not a completely secure means of communication.The Florida Health Department and the Center for Disease Control and Prevention.
I also understand and agree to the following:
I may refuse to provide this authorization.I may revoke this authorization at any time in writing.I have a right to request and receive a copy of this authorization.This authorization is effective immediately upon signing this form.
By clicking the "Submit" button below, you certify that the above information is correct and accurate to the best of your knowledge.
YOU ARE CURRENTLY NOT ELEGIBLE TO GET A BOOSTER OF THE JOHNSON COVID VACCINE
Booster shot is recommended 2 months afterthe 1st dose for elegible patients