H1N1 Vaccine Request

To assist you to get your child on our H1N1 Vaccine waiting list, you may submit your request on the form below. We need the following information:

The names and date of birth of your children needing H1N1 vaccine
FluMist or Flu shot
H1N1 1st or 2nd dose
Your name and phone number

Please click here for more information about the H1N1 vaccines. Your child may not be able to receive FluMist depending on their age and/or underlying medical condition.

Another alternative is to call 211 and check with the state for their vaccine availability. Several of our patients have done this. The state has more vaccine than they are allotting us.

Thank you for your patience!