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Last Revised: 06/2023Informed Vaccination Administration Record Patient Information: Last Name:First Name:Date of Birth:Phone Number:Address:City:Gender at Birth:Gender Identification:State:ZIP:Administrating
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Download the covid19-walmart-questionnaire-consent-formpdf from the official Walmart website.
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Submit the completed form at the designated location at the Walmart store.

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Anyone who wishes to visit a Walmart store and participate in any covid19 related activities or services.
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The covid19-walmart-questionnaire-consent-formpdf is a document required by the state for individuals to consent to participate in COVID-19 related assessments or screenings conducted by Walmart.
Individuals participating in Walmart's COVID-19 testing and screening programs are required to file the covid19-walmart-questionnaire-consent-formpdf.
To fill out the form, individuals must provide personal information such as their name, contact details, and answer health-related questions as specified in the document.
The purpose of the form is to obtain consent from individuals for participating in COVID-19 testing and to collect necessary information for health and safety assessments.
The form requires individuals to report their personal details, health condition, potential exposure to COVID-19, and any relevant medical history.
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