Staff Flu Shot information

If you are interested in receiving the flu shot here at Lilburn ES on Wednesday, September 26 immediately after school, please complete all the information below. Be sure to complete the forms #2 & #3 online and then print them out and bring them when you get your shot. #1 doesn't get printed, it is just to help Kelly know who all is coming. #4 is just to read for your information.

We will meet in the Parent Education Room for the shots, and be sure to read the bottom "other pertinent info"

Please respond to the survey in #1 by Friday, September 21 to reserve your spot.

1) Read the Flu Vaccine information sheet.
2) Complete the consent form for each person receiving the vaccine. 
3) Complete this consent form if you are pregnant. - Read this form if requesting TDaP vaccine for pregnant women.
4) Complete the Client Responsibility form.
5) Complete the survey here.


Other pertinent Info:

• Client Responsibility letter (attached) needs to be signed by everyone, who has private insurance and would like to use it. They accept (BCBS, Aetna, Coventry, Cigna, and United Health Care State Health Benefits).
• Please bring bring copies of your insurance cards (front and back) with the Primary Card holder Name and Date of Birth written on it. 
• They accept Medicare Part B insurance. These individuals need to bring copies of ALL their insurance cards (front and back).
• The discounted price  of the FLU vaccine is $30.00 for people, who do not have insurance or if they are not able to use your insurances. Please  bring cash. :)
• There is a high dose FLU shot for $65 per dose. Please bring cash :)