• Downtown Pharmacy Vaccine Screening and Consent Form

  • Vaccination Times are as follows (subject to change):

    Monday through Friday 

    10AM to 4PM

    Saturday and Sunday

    11AM to 4PM

  • COVID-19 Vaccine

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  • Pfizer-BioNTech COVID-19 Vaccine Fact Sheet

    Janssen COVID-19 Vaccine Fact Sheet

    Moderna COVID-19 Vaccine Fact Sheet

    Downtown Pharmacy HIPAA Privacy Notice

  • Emergency Use Authorization:

    The FDA has made the COVID-19 vaccine available under an emergency use authorization (EUA). The EUA is used when circumstances exist to justify the emergency use of drugs and biological products during an emergency, such as the COVID-19 pandemic. This vaccine has not undergone the same type of review as an FDA-approved or cleared product. However, the FDA’s decision to make the vaccine available is based on the totality of scientific evidence available, showing that known and potential benefits of the vaccine outweigh the known and potential risks.

  • Flu Vaccine

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  • Influenza Vaccine Information Sheet

    Downtown Pharmacy HIPAA Privacy Notice

  • Shingrix (Shingles) Vaccine

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  • Shingrix Vaccine Information Sheet

    Downtown Pharmacy HIPAA Privacy Notice

  • Patient Information

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    Consent:

    I have read, or had explained to me, the Vaccine Information Statement, Vaccine Information Fact Sheet, and/or Patient Fact Sheet about the vaccination. I have been given an opportunity to ask questions which were answered to my satisfaction (and ensured the person named above for whom I am authorized to provide surrogate consent was also given a chance to ask questions). I understand the benefits and risks of the vaccination as described and I certify the information provided regarding eligibility for the vaccine isaccurate. I request that the vaccination be given to me (or the person named above for whom I am authorized to make this request). I waive and release all claims I, or anyone claiming by or through me, now have or may hereafter acquire against Downtown Pharmacy, and their respective directors, officers, employees, and agents for any damage or injuries if I, or the person named above for whom I am authorized to make this request, contract the disease being vaccinated against, other diseases, or suffer any other adverse reactions following administration of this vaccine. I authorize release of all information needed (including but not limited to medical records, copies of claims and itemized bills) to verify payment and as needed for other public health purposes, including reporting to applicable vaccine registries. I have received a copy of the Patient Bill of Rights.

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