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  • FLU Vaccine Eligibility and Consent Form

  • This form is specific to determining if you are eligible for a Flu Vaccine. You have indicated that you are not interested in receiving a Flu vaccine. Please make sure you have selected the correct form. If you have further questions or concerns please contact us at 270-547-2855. Thanks!

  • Based on your selected age, you are not eligible to receive a Flu Vaccine at Save-Rite Drugs in Irvington. Please contact your Pediatrician, Primary Care Provider or Health Department to inquire about a Flu Vaccine for your child. If you have any questions you may contact us at 270-547-2855. Thanks!

  • FLU Vaccine Eligibility and Consent Form

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  • Please bring a copy of your prescription insurance card or Medicare Part B (Red, White and Blue card) to your appointment. If you do not have prescription insurance you may pay out of pocket for your Flu Vaccine. A high dose Flu Vaccine (for those ages 65+) will be $75 and a regular dose Flu vaccine (for ages 5-64) will be $40.

    After clicking the submit button below, you will be directed to schedule your appointment for your Flu vaccine. If you would also like to receive another vaccine during your same appointment, such as COVID-19 or Pneumonia, you must fill out another eligibility and consent form for your other requested vaccine and you will schedule a 2nd appointment for that vaccine as well.

    You will be directed on how to complete another eligibility and consent form for your 2nd vaccine when you finish scheduling your first vaccine.

    If you have any questiosn please feel free to contact us at 270-547-2855. Thanks!

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  • This QR Code will take you to the required Vaccine Information Sheet that must be offered with each vaccine given. If you wish to receive a printed copy of this VIS, please inform us when you arrive at the pharmacy. Thanks!

                                                     

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