Flu Shots
Flu shots will be administered from 9 am to 3 pm on Tuesday, November 9, 2021, BY APPPOINTMENT ONLY.
Please fill out Section A and Section B, Questions 4-6 and 8-10 ONLY, and Section D.
Do NOT sign the form until the day the vaccine is administered.
Please return the form, with a copy of your Medicare and/or insurance card(s), along with your PRESCRIPTION drug card, no later than November 5th, and call to schedule your appointment time slot.
wag VAR.pdf