Flu Registration Form

Come prepared with the necessary forms for your flu vaccine:

  1. DOWNLOAD, fill out, and print out the registration form: Click here.
  2. DOWNLOAD, fill out, and print out ONE of these screening checklists:
    • Flu shot for ages 6 months and over: Click here.
    • Intranasal flu vaccine (through the nose) for ages 2-49 years: Click here.
  3. Bring these forms, a photo ID, and your insurance card to the flu clinic.

 


  • Forms must be printed, signed, and brought to clinic.
  • For use in Lorain County Public Health 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.