Health District Consent Forms
Please enter the requested information on the appropriate Health District consent form, print it out and bring it to the clinic with you:
Adult H1N1 Consent Form (pdf)
Child/School H1N1 Consent Form (pdf)
Pre-registration with the Ohio Department of Health
Anyone interested in receiving a H1N1 vaccination is encouraged to pre-register on the Ohio Department of Health H1N1 website. This pre-registration will help the Health District in accurately reporting data back to the Ohio Department of Health and will allow you to receive emails concerning vaccine availability and timing for follow-up doses if needed. Pre-registration DOES NOT guarantee a dose of vaccine at a specific clinic nor does it replace the Health District’s consent form which must be completed prior to vaccination.
Use the following link to pre-register. Once at the site Select "New Individual/Family to Pre-Register"
https://h1n1vaccine.odh.ohio.gov
Updated: 12/01/2009