Influenza Vaccination Consent and Appointment Application
FREE Flu vaccines with most insurance plans.
This application is designed to eliminate long lines and create a limited-contact flu shot experience. Please carefully read the instructions and complete the form in its entirety.
If you plan to vaccinate multiple members in your family, you MUST complete a submission for each person immunized.
If you will be using health insurance, please have a photo ID and insurance card ready before beginning. If you'd rather self-pay, you will need a major credit or debit card to complete the registration process.
If you experience difficulties, please contact 915-533-3414 (Mon-Fri 8A-5P)