Community Health Services

Seasonal Flu Registration Information

To speed up your visit to our clinic, click on Seasonal Flu Form and complete all information requested.

You will need a Seasonal Flu form for each person needing a shot.
If you are coming in for the flu shot (not flu mist), you only need to complete and print out page 1. If your child is aged 2-18 and you would prefer the flu mist, you will need to complete and print both pages.
Bring the form(s) to the Department of Health and Human Services. We are located on the first floor, just past the security desk.
Please sign in at one of the computer kiosks. This will let the registration clerk(s) know you are here for the flu shot.
Give the form(s) to the registration clerk, along with your Insurance information (if you have third party insurance and/or Medicare Part B).
Cost for the Flu shot is $20 for anyone over 18 years old; children are free.

Seasonal Flu Form

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