Influenza Vaccine Screening                          Westchester County Center

Please fill out this form. A patient services representative will then contact you to schedule your appointment. 
*Must be 7 years or older.
*Masks: Everyone is required to wear a mask once they enter the Westchester County Center.
*For those ages 65 and older, a High Dose of the Influenza Vaccine is recommended. We do not offer High Dose at this site. Please contact your primary care physician. If you do not have a primary care physician, please contact our Internal Medicine Practice at 914-594-2400 for an in person visit. *Stay Home If Sick: If you have the following symptoms: fever, chills, new cough, difficulty breathing, sore throat, muscle or body aches, vomiting or diarrhea, or new loss of taste or smell, please cancel your appointment through your patient portal or by calling the call center at 914-909-6754.


Notice:
We are currently only offering the Influenza vaccine to anyone over 7 years of age at the Westchester County Center. Please contact your primary care physician. If you do not have a primary care physician, please contact our Internal Medicine Practice at 914-594-2400 for an in person visit. 






Notice:
Due to selecting YES to any of the questions #3-#7, you have not met the WMC Criteria for obtaining the influenza vaccine at the Westchester County Center. Please contact your Primary Care Physician at this time. If you do not have a primary care physician, please contact our Internal Medicine Practice at 914-594-2400 for an in person visit. 
Patient Group

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Consent
I have read the document in the link below and consent to the vaccine.
https://www.cdc.gov/vaccines/hcp/vis/vis-statements/flu.pdf