notice
COVID-19 Vaccine Consent Form
May 10, 2023 · Republic, KS
📄
Source: Moderna COVID Vaccine Consent
(PDF, 2 pp)
Retrieved May 10, 2026
from republiccounty.org ↗
Confidence:
90%
High
Summary
The Republic County Health Department is providing a COVID-19 vaccine consent form for individuals to sign before receiving the vaccine. The form includes information about the vaccine, potential side effects, and a release of liability. The department is also providing information on what to do if you have a reaction to the vaccination.
Details
- Contact
- Republic County Health Department, 2316 G Street, Belleville, KS 66935, Ph. 785.527.5671 | Fax 785.527.2892
- Subject
- COVID-19 Vaccine Consent Form
- Summary
- The Republic County Health Department is providing a COVID-19 vaccine consent form for individuals to sign before receiving the vaccine. The form includes information about the vaccine, potential side effects, and a release of liability. The department is also providing information on what to do if you have a reaction to the vaccination.
- Location
- 2316 G Street, Belleville, KS 66935
- Issuing Body
- Republic County Health Department