Flu Clinic: October 22, 10 AM - 2 PM
Health Sciences and Human Services Library
601 W. Lombard Street, Baltimore, MD 21201
1st Floor

To help us better serve you, please review the checklist below and feel free to download the printable consent form to complete it before your arrival. Consent forms will also be provided at the door.

Spouses and children of staff (9 years of age or older) may attend with appropriate ID and insurance cards.

The cash cost of the Influenza vaccination without insurance is $35.00.

All flu shots are preservative free.
Email address *
Please remember to bring:
Photo ID (Required)
Insurance card (Physical card or physical copy of your card required if using your insurance, Amerigroup and United Healthcare are NOT accepted)
Payment (Required if not using your insurance)
Consent Forms (Will be provided at the door but a pre-filled form may expedite your visit)

Printable consent form: https://www.walgreens.com/images/adaptive/si/pdf/immunizations/WAG_VAR_Form_EDIT_10172013_v1.pdf

Last Name *
Your answer
First Name *
Your answer
Please select one: *
Phone Number *
Your answer
UMB Affiliation *
Have you had a flu shot before? *
Do you plan to use your insurance? *
What time would you like to attend? *
A copy of your responses will be emailed to the address you provided.
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