Flu Vaccine (Adult) Name(Required) First Last Date of Birth(Required) Today's Date(Required) MM slash DD slash YYYY Consent(Required) I certify that:+ I am at least 18 years old. + Kids Plus Pediatrics may bill my insurance for the flu vaccine. + I consent to receiving the flu vaccine administered by a Kids Plus staff member.Please type your full name, to serve as your electronic signature.(Required) CAPTCHA
