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Flu Shot Consent Form 

Prepare your family for flu season!

Drive-Thru Flu Shot Clinic at Hawarden Regional Healthcare Clinic 

Wednesday, Sept 15th  9:00 -11:00 AM

Thursday. Sept 16th 3:00-6:00 PM

We can submit to your insurance. Self-pay cost for the flu vaccine:
• $25 – 6 months and older
• $50 – high dose vaccine recommended for individuals 65 years and older

*Face masks are required for patients over 2 years old. 

FOR FASTER SERVICE, fill out the vaccine consent form in advance and bring it with you, along with a copy of your insurance card. 

 Flu Shot Consent Form 


Please remember:

- Photo ID and Insurance Card

- Wear loose clothing to show upper arm

- Young children wear shorts

If you can’t make one of the Drive-Thru Clinics, please schedule a nurse visit by calling:

Hawarden Clinic - 712-551-3400

Ireton Clinic - 712-278-1011

Akron Clinic - 712568-2411


Who should get a flu shot:

-All children and adults, especially those 65 years of age and older.

-Pregnant women.

-Healthcare workers.

-People with asthma, heart disease, diabetes, or weakened immune systems.

-Caregivers of children under 5 years old.

Who should NOT get a flu shot:

-Infants younger than 6 months of age.

-Anyone who has had a severe reaction to the flu vaccine in the past.

-Anyone who currently has a moderate or severe illness or fever.