Flu Vaccine Consent Form

Arm Yourself with a Walgreens Flu Shot.

Save Time during Your Flu Shot Visit

Sign in to your account to download your 2010-2011 Flu Vaccine Form with your primary personal information already filled in. Simply print your form and bring it to the pharmacy on the day of your visit.*

Register for an Account Online

If you're new to Walgreens Pharmacy, it's easy to create a pharmacy account online. Once your registration is complete, your local pharmacy will have all the information they need when you arrive for your flu shot.*



*State, age and health-condition related restrictions apply. Other vaccines may be available. See pharmacy for details.




Walgreens: Vaccines subject to availability and immunizing professionals on duty. State, age and health-condition related restrictions apply. Other vaccines may be available. See the pharmacy for details.

Take Care: Vaccines subject to availability and immunizing professionals on duty. State, age and health-condition related restrictions apply. Other vaccines may be available. See clinic for details. Patient care services provided by Take Care Health Services sm , an independently-owned professional corporation.

Medicare Part B: Medicare Part B generally covers one flu vaccine per beneficiary per flu season.

Flu Vaccine Resources

Print a blank
Flu Vaccine Consent Form (PDF).*

Read What You Need to Know about the Influenza Vaccine (PDF).

Flu Vaccine Locator

Find a Walgreens stores near you that administers the flu vaccine:

Walgreens Near You

Track your immunizations online

View and Track immunizations and vaccinations you've gotten at Walgreens with our Immunization Tracker