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Flu Shot Materials

Flu Shot Consent and Release Form
The following two items are required for use during flu shot clinics. Please make the necessary copies based on the number of expected participants. (We recommend that you have the necessary copies of both forms available to give to the nurse(s) when the participants arrive prior to the clinic:)

Also recommended:

  • Flu Facts

This document includes information about the flu virus and vaccine based on the current report on prevention and control of influenza by the CDC Advisory Committee on Immunization Practices (ACIP). You do not need to print it as a handout for every participant, but you may find it helpful in answering questions you or your company’s employees might have.


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Medicare Part-B
For Medicare Participants Only
The following two items are required for use during flu shot clinics. Before your flu shot clinic, please make the necessary copies based on the number of expected participants. (We recommend that you have the necessary copies of both forms available to give to the nurse(s) when the participants arrive prior to the clinic:)

Also recommended:

This document includes information about the flu virus and vaccine based on the current report on prevention and control of influenza by the CDC Advisory Committee on Immunization Practices (ACIP). You do not need to print it as a handout for every participant, but you may find it helpful in answering questions you or your company’s employees might have.


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