Resident Vaccine Portol | Bothell Health Care

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NEW Covid-19 VACCINE BIVALENT BOOSTER

& HIGH DOSE QUADRIVALENT FLUZONE VACCINE

The clinic will begin in October. Please let us know if you are wanting your loved one to receive the Moderna Covid-19 Vaccine Booster or FLUZONE vaccine or BOTH.

YES I would like my loved one to get the NEW COVID-19 BIVALENT BOOSTER

YES I would like my loved one to get the QUADRIVALENT FLUZONE VACCINE

NO I would NOT like my loved one to get either vaccine

Initials

Date

I declare that the information I’ve provided is accurate & complete

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