LECOM - Community Flu, COVID-19 Vaccination & Booster Clinic for Individuals Ages 5+ hosted by NESD

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LECOM - Community Flu, COVID-19 Vaccination & Booster Clinic for Individuals Ages 5+ hosted by NESD - Please register each adult and/or child.

LECOM in conjunction with the Erie County Department of Health will be hosting a community COVID-19, flu, vaccination and booster clinic on Wednesday, December 7th, 2022. The clinic will be held at the North East Middle School from 3:00 p.m. to 6:00 p.m. The clinic is open to anyone in the community 5 years old and up. It is also recommended that you consult your family physician prior to receiving any vaccine.

Please select a time slot between the hours of 3:00 p.m.- 6:00 p.m. . *Please note, if too many appointments are booked for one time slot, we may contact those who signed up last to reschedule for a different time slot.* LECOM also asks that you be patient as registration does take some time. Please fill one for each member of your family, if applicable.

Email *

Phone Number *

I am registering for the FLU Vaccination (Select one)

Fluzone (5 years and older)

Fluzone High Dose (65 years and older)

Flublok Egg-free (18 years and older)

I am registering for a COVID Bivalent BOOSTER (ages 5 and up) Select one. *

Bivalent (Pfizer)

Bivalent (Moderna)

Required

I am registering for the Novavax (non- MRNA Vaccine) initial dose (12 years and older)

Novavax

Last Name (minor child last name if registering minor or self if over the age of 18) *

First Name (minor child first name if registering minor or self if over the age of 18) *

Date of Birth (DOB of minor child or DOB of person over the age of 18) *

YYYY

Appointment Time Preferred (We will notify you of your appointment time slot is full) *

3:00 PM - 3:15 PM

3:15 PM -3:30 PM

3:30 PM - 3:45 PM

3:45 PM - 4:00 PM

4:00 PM - 4:15 PM

4:15 PM - 4:30 PM

4:30 PM - 4:45 PM

4:45 PM - 5:00 PM

5:00 PM - 5:15 PM

5:15 PM - 5:30 PM

5:30 PM - 5:45 PM

Required

Acknowlegement *

I request that the minor child listed above receive the COVID-19 vaccine OR booster as part of this vaccination clinic.

I am an adult above the age of 18 and requesting to receive the COVID-19 vaccine or booster as part of this clinic.

Required

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

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