Flu Registration Form

Depending on the type of vaccine you would like to receive, please click on the appropriate form, fill it out completely, print it, and bring it with you to the flu clinic. 

 


Injectable Vaccine

This vaccine is s traditional shot with a needle, usually into the arm, and is recommended for all ages 6 months and older. Complete and print the form below if you want to receive this vaccine.

 

Injectable Vaccine Form 

 


Intranasal Vaccine **Due to a region-wide shortage, the Lorain County General Health District cannot provide the intranasal vaccine.**

This vaccine is sprayed into the nose and is only for people ages 2 to 49. Complete and print the form below if you want to receive this vaccine. Depending on your answers to the questions on the forms, you may need to receive the injectable vaccine (a shot into the arm) instead.

 

Intranasal Vaccine Form

 


  • Form must be printed, signed, and brought to clinic.
  • For use in Lorain County General Health District Clinics only.
  • One form per person is required for vaccine.
  • If you are under 18 then you must be accompanied by a parent or guardian.

 

Flu RSS Aggregator

Flu RSS Aggregator Widget. Flash Player 9 is required.
Flu RSS Aggregator Widget.
Flash Player 9 is required.