FLU Shot Appointments

Influenza Clinic 2-18-22
- FLU Shots will be available from 9 am to 12 noon on 2-18-22 at 318 Fairlane Drive, Viroqua in the Erlandson Building on the 2nd floor, Health Department.
- Please bring any insurance verification cards with you.
- If you wish to pay out of pocket the fee is $30 for a standard vaccine, $50 for Flublok (over the age of 65 high dose) vaccine, and children (18 and under) are free.
- Please print and complete the FLU consent form. Bring it with you to your appointment.
Patients Information
Full Name *
Phone Number

Area Code Phone Number
Date of Birth *

Day Month Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Appointment
Please print the FLU consent form below, complete the top section and bring the form with you to your appointment.
Should be Empty:

Patients Information