Clinic forms:

Please bring the following forms with you to the clinic. If you are having trouble filling out the forms we will assist you at the clinic.

*If you are receiving the intranasal vaccine, please complete the following questionnaire and bring it with you to the clinic: English / Spanish

*H1N1 Vaccination Administration Record Form (in English), click here.

*H1N1 Vaccination Administration Record Form (in Spanish), click here.

For instructions on completing the H1N1 Vaccination Administration Record Form, click here

Please review the following:

H1N1 Intranasal Vaccine Information (Spanish)

H1N1 Injectable Vaccine Information (Spanish)

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