Flu Clinic on October 22, 2020

Register for the Flu Clinic on October 22, 2020 at the Little Valley American Legion, 5899 NY-353, Little Valley, NY 14755.

Patient Name
Your Address
Do you have health insurance?
Health Insurance Info
Health Insurance carrier's Name (i.e. Independent Health, Blue Cross/Blue Shield, Fidelis, etc.)
Health Insurance Group Number
Screening Checklist

Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination

For patients (both children and adults) to be vaccinated: The following questions will help us determine if there is any reason we should not give you or your child inactivated injectable influenza vaccination today. If you answer "yes" to any question, it does not necessarily mean you (or your child) should not be vaccinated. It just means additional questions must be asked. If a question is not clear, please ask your healthcare provider to explain it.