Please click the link on Vaccine Information Sheets below.
Vaccine Information Sheets
I have read or had explained to me the “Vaccine Information Sheets” and understand the risks and benefits of the vaccine(s) that are being administered.
I understand that this information may be shared with the patient's health care providers directly involved in the patient's care. I understand that this information will be entered into a statewide online vaccine registry. No payment is required from you for this program. Medicaid and Badgercare however will be billed to help cover the cost of the immunization program.
If your child has Medicaid or Badgercare, please provide the Child’s 10 digit ID number below: