Staff Flu Shot information
If you are interested in receiving the flu shot here at Lilburn ES on Wednesday, October 12 immediately after school, please complete all the information below. Be sure to complete the forms #2 & #3 on line 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.
Please respond to the survey in #1 by October 6 to reserve your spot.
1) Complete the survey here.
2) Complete the consent form for each person receiving the vaccine.
3) Complete the Client Responsibility form
4) Read the Flu Vaccine information sheet.
Other pertinent Info:
Please respond to the survey in #1 by October 6 to reserve your spot.
1) Complete the survey here.
2) Complete the consent form for each person receiving the vaccine.
3) Complete the Client Responsibility form
4) Read the Flu Vaccine information sheet.
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 $56 per dose. Please bring cash :)
