NEXT FLU CLINIC: SATURDAY, NOVEMBER 4TH

Location: 6 Tsienneto Road, Derry (Suite 100)

Please fill out this request and your spot will be confirmed via a text message (Klara) or a phone call.

PATIENT FIRST NAME*
PATIENT LAST NAME*
PATIENT DATE OF BIRTH (MM/DD/YYYY)*
MOBILE PHONE NUMBER*
PARENT/GUARDIAN FIRST NAME (IF PATIENT IS A MINOR)
PATIENT GUARDIAN LAST NAME (IF PATIENT IS A MINOR)
TYPE OF FLU VACCINE
PREFERRED METHOD OF CONFIRMATION FOR FLU SHOT CLINIC APPOINTMENT*
- TEXT MESSAGE (KLARA)
- PHONE CALL
We will text or call to confirm your flu shot appointment. Please note that Saturday Flu Clinics run from 9:00 am - 11:00 am only and are located at 6 Tsienneto Road in Derry.
IF YOU DO NOT HAVE A MOBILE PHONE OR IF YOU DO NOT TEXT, PLEASE LEAVE A PHONE NUMBER BELOW.