Scheduling form for 2 children

For help with any of the items on this form, please view the FAQs and info section on the main page.

Parent's contact info
Parent's name *
Parent's name
Phone *
Phone
Child 1
Name *
Name
FluMist will be available for children 2 years and over for the November and December flu clinics (pending their arrival); certain conditions exclude children from this vaccine and you can talk to Dr. Joel or Dr. Meri about this as needed.
If your child is less than 9 years old AND hasn't had at least 2 or more doses total in their lifetime, they'll need 2 doses (separated by 4+ weeks). Otherwise, just 1 dose.
Date(s) *
If your child needs 2 doses, select two dates, otherwise select just one date.
Child 2
Name *
Name
FluMist will be available for children 2 years and over for the November and December flu clinics (pending their arrival); certain conditions exclude children from this vaccine and you can talk to Dr. Joel or Dr. Meri about this as needed.
If your child is less than 9 years old AND hasn't had at least 2 or more doses total in their lifetime, they'll need 2 doses (separated by 4+ weeks). Otherwise, just 1 dose.
Date(s) *
If your child needs 2 doses, select two dates, otherwise select just one date.
Most questions are answered in the FAQ and info section of the main page. If not, please add any comments or special circumstances here. Thanks!