Form

General consent form template for immunisation

This template form is for health professionals to give to parents/guardians for them to give permission for their child to be vaccinated.

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Please see vaccine specific example consent forms for human papillomavirus (HPV), MenACWY and flu.

Documents

General consent form template for immunisation

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Details

This form is for health professionals to give to parents, either by hand or by post, preferably with an accompanying information leaflet. It has been produced in a template format in response to requests for a single ‘generic’ consent form that can be adapted for use with any vaccine rather than having a lot of individual vaccine-specific forms.

This template can be downloaded and adapted on screen, with the name of the vaccine and other details inserted as appropriate. Alternatively, it can be printed out and annotated by hand and then photocopied if desired.

Published 15 October 2013
Last updated 28 October 2013 + show all updates
  1. Uploaded a new version of the consent form. Updated the narrative in the summary and detail section.
  2. First published.