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NORTH CENTRAL DISTRICT HEALTH DEPARTMENT 20212022 SEASONAL INFLUENZA IMMUNIZATION CONSENT FORM Please print clearly Name (please print) Street Address Town, State & Zip Code INSURANCE: AETNAANTHEMCIGNACTCAREDate

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What is naugatuck valley health district?

Naugatuck Valley Health District is a local health department serving the towns of Beacon Falls, Naugatuck, Seymour, and the City of Ansonia in Connecticut.

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The purpose of the Naugatuck Valley Health District is to protect and promote the health of the communities it serves through various public health initiatives and programs.

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Information such as business details, health and safety practices, and compliance with health regulations may need to be reported on the Naugatuck Valley Health District forms.

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