Vaccination Reservation Form

The Clinton County Health Department will be on campus August 22nd to provide immunizations. If you are missing any of the REQUIRED immunizations please plan to arrive with records showing your have received the necessary vaccinations. If you do not have records you will be required to get the immunizations from the health department. To help ensure availability please RESERVE your immunizations by completing this form. You will need to pay cash at the time of service. For information on cost please call the CCHD at 937-382-7221. If you have other questions please call Jill Young, Director of Health Services at 937-382-6661 x217.
Reservations must be made by August 5, 2013.
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