Flu Vaccine Clinic

September 2023 

Dear Parent/Guardian and School Staff, 

Margaret Mary Health will do a Flu Vaccine Clinic at school on 10-10-23 for students and staff. 

The online form must be submitted by: September 28th, 2023 

  • To complete the required form, read the following directions and then click on the link below. 
  • The document is password protected.  
  • Acknowledge the Adobe terms by clicking “continue” at the bottom of your screen. 
  • Enter legal names 
  • Date: The format must be 8 digits and use forward slashes. month/day/year i.e. 12/30/2009 
  • Every line with a red * must be completed. 
  • Yellow fields are not required, but highly recommended if submitting to insurance. A copy of both sides of the insurance card is NOT required. 
  • The address to send claims can be found on your insurance card. 
  • After forms are complete, a “Click to Sign” button will appear. If it does not appear, look over the form for incomplete required fields. 
  • After entering an email, a “Click to Sign” button will appear. 
  • Go to your email. An email will be sent from Adobe Sign. Click on the “Confirm my email address.” 
  • After confirming your email address, your part is complete. 

Link:  Vaccine Consent – Flu Only 


Insurance: Please contact your insurance company to verify eligibility, coverage, and location limitations. Some insurance companies will not cover the flu vaccine if it is administered in a school setting. Immunizations are billed as ‘preventative’ and may be covered under the wellness category of your insurance plan. MMH’s provider is Michael Parker, DO. The insurance company makes the final determination of your eligibility and coverage. 

Vaccine for Children and 317 Programs: These programs provide flu vaccine at no cost to those who have no insurance, Medicaid or have insurance which does not cover vaccines.  

Flu Vaccine Information Sheet can be found at: Vaccine Information Statement: Inactivated Influenza Vaccine (cdc.gov)