I have been given a copy and have read, or have had explained to me, the information of the Vaccine Information Sheet (VIS) provided by the Centers for Disease Control (CDC) for each vaccine I/my child am to receive today.
I have had a chance to ask questions and they have been addressed to my satisfaction.
I understand the benefits and risks of each vaccine to be given.
I give my consent for each of the vaccines to be given to me/my child at this time.