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Summit County Public Health Influenza Vaccine FAMILY Formally Mailing Address: ___ City: ___ State: ___ Zip: ___ Phone: ___ PLEASE ANSWER THE FOLLOWING FOR EACH PERSON TO BE VACCINATED: Name (1):
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Download the Summit County Influenza Vaccine Family Form from the official Summit County Public Health website.
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Fill out the required information on the form, including the names and ages of all family members requiring the vaccine.
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Provide any additional necessary information, such as medical conditions or allergies, if applicable.
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Submit the completed form to the designated submission method specified on the form or the website.

Who needs summitcountycogovinfluenza-vaccine-family-formsummit county public health?

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Anyone who wishes to receive the influenza vaccine from Summit County Public Health needs to fill out the Summit County Influenza Vaccine Family Form. This includes individuals of all ages, from children to adults, who require the vaccine.
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Summit County Public Health is a government agency in Summit County, Ohio that provides various public health services to the community.
Individuals who are eligible and wish to receive influenza vaccines for themselves or their family members may be required to fill out the form.
The form can be filled out electronically or in person at the Summit County Public Health offices.
The purpose of the form is to gather information about individuals who are seeking influenza vaccines for themselves or their family members.
The form may require information such as demographic details, medical history, and insurance information.
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