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Boone County Health Center FLU VACCINATION Consent Form PLEASE PRINT CLEARLY. LAST NAME: ___ FIRST NAME: ___MIDDLE INITIAL: ___ADDRESS: ___ CITY:___ STATE:___ ZIP:___ PHONE NUMBER: ___ DATE OF BIRTH:___
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Step 1: Visit the website boonecohealth.org
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Step 2: Look for the 'Flu Vaccine Consent' form
03
Step 3: Download and print the form
04
Step 4: Fill out the form with your personal information
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Step 5: Read the consent statement carefully and sign the form
06
Step 6: Submit the completed form to the Boone County Health Center

Who needs boonecohealthorg09flu-vaccine-consentboone county health center?

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Anyone who wants to receive a flu vaccine at Boone County Health Center needs to fill out the 'Flu Vaccine Consent' form.
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Boone County Health Center is a healthcare facility located in Boone County.
All individuals who wish to receive a flu vaccine at Boone County Health Center.
The form can be filled out online on the Boone County Health Center website or in person at the facility.
The purpose is to provide consent for receiving a flu vaccine at the health center.
Personal information, medical history, and consent for the flu vaccine.
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