Flu Clinic (Program) Required Forms
The following three forms must be completed prior to receiving a flu vaccine. You can pick up these forms at any of the Flu Clinics (Programs) offered at the Wilce Student Health Center, or you can download them here and complete them in advance.
- Flu Clinic - Patient Questionaire (PDF)
- Complete the top portion of this form to aid the provider in determining if you can receive the vaccine.
- Flu Clinic - Service Sheet (PDF)
- Complete the top portion of this form for indentification & billing purposes.
- Notice of Privacy Practices Acknowledgement (PDF)
- Complete this form to acknowledge you have received information on the SHS privacy practices.