Consent & Liability Waiver Name * First Name Last Name Phone * (###) ### #### Email * Do you have any allergies (including to medications or vaccines)? * Yes No Have you ever received a booster shot before? * Yes No Are you currently pregnant? * Yes No Consent and Acknowledgment * I acknowledge that I am voluntarily receiving a booster shot from The Pregnancy Bar. I understand that: Booster shots are not a substitute for medical treatment or advice. Possible side effects may include mild discomfort, soreness, or allergic reactions. I have disclosed all known medical conditions, allergies, and medications. I have had the opportunity to ask questions and have received satisfactory answers. I release and hold harmless The Pregnancy Bar, its owners, employees, and contractors from any and all liability for injury, loss, or damages resulting from my participation. By signing below, I consent to The Pregnancy Bar contacting me for light marketing purposes, such as wellness updates, promotional offers, or event invitations. I consent I do not consent Thank you!
