North Brookfield Schools & Community Vaccine Clinic

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The North Brookfield Board of Health, North Brookfield Public Schools, and Hannaford Pharmacy have partnered to provide a vaccine clinic at the North Brookfield Elementary School (10 High School Dr.) on Wednesday, November 8th from 2:45 - 6:00 pm.

The clinic is open to all NB residents as well as those of neighboring towns.

We will have Moderna Covid-19 vaccine for ages 12+ as well as Influenza vaccine for ages 5+.

Please sign up for a time on the form below.

You will need to fill out the form separately for each person who will be receiving a vaccine. If you would like, you may receive both COVID and Flu vaccines.

Please print and fill out the informed consent form linked below and bring with you to your appointment. There will be forms available at the clinic if you cannot print at home.

Please do NOT sign the form - you will be asked to sign when receiving your vaccine.
Form: https://bit.ly/402hzDg

Bring an ID and your insurance information, and wear short sleeves or loose-fitting clothing to your appointment.

Email emelad@northbrookfield.net if you have questions or issues with signing up.
Thank you!

Email *

Last Name *

First Name *

Age *

Town of Residence *

Phone # *

Choose a vaccine:

Patients may choose both Covid-19 vaccine as well as Flu vaccine if desired.

COVID-19 age 12-17

COVID-19 age 18+

Seasonal Influenza Vaccine - Child

Seasonal Influenza Vaccine - Adult

Seasonal Influenza Vaccine - Senior

Required

Choose an appointment time

(If times are not visible, that slot has been filled)

3:15 PM

3:25 PM

3:35 PM

3:45 PM

3:55 PM

A copy of your responses will be emailed to the address you provided.

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