I certify that I am at least 18 years old or that I am the legal guardian of the patient. I hereby give my consent to the staff of Sona Pharmacy to administer vaccine(s) that I have requested. I understand that it is not possible to predict all possible side effects or complications associated with vaccines. I understand the risks and benefits associated with the above vaccine(s) and have received, read and/or had explained to me the Emergency Use Authorization (EUA) on the vaccine(s)I have elected to receive. I also acknowledge that I have had a chance to ask questions. I, on the behalf of myself, my heirs, executors, personal representatives, agents, successors, and assigns hereby agree to release, indemnify, and hold harmless Sona Health, Inc., its subsidiaries, divisions, affiliates, agents, officers, directors, contractors, and employees from any claims arising out of, in connection with, or in any way related to the administration of the vaccines listed above. I authorize Sona Health, Inc., as applicable, to release my medical or other information to, or through, the COVID Vaccine Management System to my healthcare professionals, Medicare, Medicaid, or other third-party payer as necessary to effectuate care or payment, submit a claim to my insurer for the above requested vaccine(s), and request payment of authorized benefits to be made on my behalf to Sona Health, Inc., as applicable, with respect to the above requested items and services. I further agree to be fully financially responsible for any co-sharing amounts, including copays, co-insurance and deductibles for the requested vaccine including any not covered by my insurance benefits. I understand that if my insurance denies my claim for any reason, I will recieve a bill for the above requested vaccine from Sona Health, Inc.