Little Silver Pediatrics and Family Medicine •  200 White Road • Suite 212 •  Little Silver, NJ 07739   732-741-5600
Read Our Reviews >>


Flu Vaccine Consent

Flu Vaccine Consent

Flu Vaccine 2020-2021 Season
  • You must complete a CONSENT FORM permitting us to give you the Influenza vaccine.
  • Submit ONE CONSENT FORM FORM EACH FAMILY MEMBER receiving the flu shot.

Click the link below to complete the flu vaccine consent form.

FLU CLINIC DATES: Sunday, October 9th, and Sunday, October 16th from 9:00 am to 1:00 pm. The rain date for both clinics is Sunday, October 23, 2022. You must submit the consent form(s) by 7 pm Sunday, October 2, 2022 to receive your flu clinic appointment

Safety Requirements

  • Be Prepared and Be Patient.
  • CHILD SAFETY. For those with young children, we request one adult be in the back seat with the child. If only one adult will be in the car, please call our office so we can make special arrangements.
  • CLOTHING SUGGESTIONS. Uncover shoulders and thighs. Adults and children over 2 years old will get their shot in the arm and should wear a sleeveless shirt/t-shirt. Children under two will receive the vaccine on their thigh.
  • MASK UP! Please make sure your mask covers your nose and mouth while you wait for your flu shot.
  • COVID-19 PRECAUTIONS: All patients receiving the flu vaccine must be free of any covid-19 symptoms, including cough, fever, shortness of breath, and diarrhea for 14 days or more. If you have any symptoms on the day of your visit, please let us know and we will postpone your visit.
  • While we have taken steps to make the drive-through clinics safe, convenient, and efficient, please anticipate wait times in your schedule.