Corktown Medical Centre Flu Shot Consent
IMPORTANT: A separate consent must be completed for EACH PERSON receiving the seasonal influenza vaccination.

Flu shots administered at Corktown Medical Centre are only available to patients who are registered to doctors at the clinic.

If you are not registered, you will need to get your flu shot at a public health flu shot clinic or at a pharmacy that administers vaccinations. Due to ongoing COVID-19 pandemic there will not be exceptions.

ONLY COMPLETE THIS FORM IF YOUR INTENTION IS TO RECEIVE THE SHOT IN CLINIC AT CORKTOWN MEDICAL CENTRE. DO NOT COMPLETE IF YOU WILL GET YOUR SHOT AT AN ALTERNATE FLU SHOT CLINIC OR PHARMACY.
I understand that a separate online consent must be completed for each individual that needs vaccination. *
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