Clermont County Public Health School Immunization Clinic Registration
Clermont County Public Health is pleased to be partnering with your school to provide immunizations to incoming 7th and 12th grade students for the 2019-2020 school year.
In order for your child to receive immunizations at this clinic, please do the following:
Complete this registration form at least one week prior to the scheduled clinic date at your child's school. Clermont County Public Health utilizes a HIPAA compliant version of SurveyMonkey to collect all registration information. Registrations entered after this date will not be accepted. Questions with an asterisk (*) are required.
A parent or legal guardian of the child receiving immunizations must be present in order for the child to be vaccinated. Children presenting to the clinic without a parent or legal guardian will not be seen.
You must bring a copy of your child's immunization record to the clinic. Children presenting to the clinic without a copy of their immunization record will not be seen. If you do not have a copy of your child's immunization record, please check with your health care provider or school nurse.
You must bring your child's insurance card to the clinic.
If you need assistance completing this form, or you have questions, please call Clermont County Public Health at (513) 735-8400 during normal business hours (Monday - Friday, 8:30 a.m. - 4:30 p.m.). A staff person will be happy to assist you.
Prior to completing this form, please visit the Clermont County Public Health webpage, Back to School Immunizations, to review and print copies of the Financial Policy, HIPAA/Notice of Privacy Practices document, and the Vaccine Information Statements for each of the vaccines you wish for your child to receive. You will be asked at the end of this registration to acknowledge receipt of these items. If you have questions about any of these documents or have questions about vaccines, please call Clermont County Public Health at (513) 735-8400 during normal business hours (Monday - Friday, 8:30 a.m. - 4:30 p.m.). A staff person will be happy to assist you.