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

To Make an appointment call: 732-741-5600
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Flu Vaccine Consent

Little Silver Pediatrics and Family Medicine will hold our 2024 drive-through flu clinics on Sunday, October 6th and October 13th, 2024 from 9:00 am to 11:30 am. To schedule your appointment, please click on the button below to complete the Flu Consent Form. Upon receipt of the consent form for you/your family members, we will send your appointment confirmation date and time.

  • You must complete a CONSENT FORM permitting us to give you the Influenza vaccine.
  • Submit ONE CONSENT FORM FOR EACH FAMILY MEMBER receiving the flu shot.

For common questions or additional information, click here 

Link to Flu Consent Form

FLU CLINIC DATES: Sunday, October 6th, and Sunday, October 13th from 9:00 am to 11:30 am. You must submit the consent form(s) by Thursday, September 26th to receive your flu clinic appointment.

Safety Requirements

  • Be Prepared and Be Patient.
  • NO PETS ARE PERMITTED IN THE CAR.
  • 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.
  • COVID PRECAUTIONS: All patients receiving the flu vaccine must be free of any COVID-19 symptoms, including cough, fever, shortness of breath, and diarrhea for 7 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.

Additional information:

CDC:  Information on Flu Season 2024-2025
March of Dimes: Influenza and Pregnancy
Vaccine Information Sheet (VIS): Flu Vaccine Information Sheet