FLU READY NOLA VACCINATION EVENTS
Thank you for registering for a Flu Ready NOLA Vaccination event.
Please fill out this form with the most up-to-date information. Once submitted, you will receive confirmation of your appointment.
Sign in to Google
to save your progress.
Last Name of the person to be vaccinated
First Name of the person to be vaccinated
Phone number (include area code) for person to be vaccinated.
Please provide email address for person to be vaccinated (if applicable).
Please select date to receive your flu vaccination:
10/15/22: Joe Brown Park ~ Gymnasium • 5601 Read Blvd.
10/22/22: Andrew Sanchez & Copelin Byrd Multi-Purpose Center • 1616 Fats Domino Way
11/12/22: Milne Recreation Center • 5420 Franklin Avenue
12/10/22: New Orleans East Hospital • 5620 Read Blvd
Please select appointment time:
10 AM - 10:30 AM
10:30 AM - 11 AM
11 AM - 11:30 AM
11:30 AM - 12 Noon
12 Noon - 12:30 PM
12:30 PM - 1:00 PM
1:00 PM - 1:30 PM
Interested in receiving COVID vaccination? If yes, please check appropriate response
First Time Covid Shot
Second Covid Shot
Please select the age of the person to be vaccinated. **Please note: Persons to be vaccinated must be 7 years of age or older.
Thank you for completing your registration. We look forward to seeing you at the vaccination event.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service