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

Flu Vaccine Consent

Flu Vaccine 2020-2021 Season

Once registered for the flu vaccine clinic, you must complete the flu vaccine consent form for each family member receiving the flu vaccine. Please complete and submit the consent form promptly.

You must submit your consent form by 7 pm Thursday, October 7th, 2021 to receive your flu clinic appointment.

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

FLU CLINIC DATES: Sunday October 10th and October 17th from 9:00 am to 1:00 pm. The rain date for both clinics: October 24, 2021

Please select at least one date that works for you. To minimize wait times and long lines, we will schedule patients into one-hour blocks within the day(s) you selected.

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.