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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

Thank you for reserving your spot at our annual drive-through flu clinic.  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.

FLU CLINIC DATES: Sunday, October 1st, and Sunday, October 8th from 9:00 am to 1:00 pm. You must submit the consent form(s) by 7 pm Sunday, October 22, 2023, 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.
  • 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.