JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Winston-Salem/Forsyth County Flu Clinic 2024- November 8, 2024
Please complete this form for you and each insured dependent (3+) coming with you. Other immunizations are available. See list below.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First name
*
Your answer
Last name
*
Your answer
Birth Date
*
Select your birthday from the drop down below.
MM
/
DD
/
YYYY
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Winston-Salem/Forsyth County Schools.
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report