Flu Shot Clinic 2021

Get Your Free Flu Shot!

Everyone 6 months and older should be vaccinated for the flu.

No ID nor health insurance required, this program is completely free and open to the public.

The Lions Global Initiative for Health and Wellness (GIHW) will be providing free flu shots in October and November at the Lions GIHW San Mateo Free Clinic in cooperation with Samaritan House and the Lions Multi-Club Medical Team.

Dates currently scheduled:

October 9, 16, 17, 23, 30, 31 and November 14, 20, 21. 10 am – 2 pm

Location: GIHW Global Lions Free Clinic - San Mateo

19 W 39th Ave. Ste. #5, San Mateo, CA 94403

Registration for Free Flu Shot Appointment

Not able to view the form below? You can click on the following link to complete your registration in a separate window/tab: https://forms.gle/EGZH28FR826xZ9Ep9

Waivers

Anyone receiving a flu shot will have to fill out the following waivers. Paper copies of these waivers will be available on site to fill out, but you can save time by printing them at home and filling them out in advance.

If the person receiving the flu shot is under the age of 18, all fields requesting their signature should instead be signed by their parent or guardian, with a note below indicating such.

One per person receiving flu shot, only first page needs to be printed

Contraindications Checklist.pdf

One per group/car (fill one line per person receiving flu shot)

If there are patients who are (1) pregnant OR (2) age 6month-3years old in your group, please put them on a separate form.

SMC Health Authorization Form 2021.pdf

One per group/car receiving flu shot. Head of household should fill the top section, and other members listed as members of the household.

GIHW clinic registration.pdf

Disclosures/Medical Information

COVID-19 Precautions

  • Per San Mateo County Health Orders, all persons at our indoor clinic must wear a well fitting mask/face covering.

  • If you have experienced any of the symptoms of COVID-19 within 24 hours prior to your appointment, we ask you cancel/reschedule your appointment for another date.

Vaccine Information Statement (2021)

Vaccine Information Statements (VISs) are documents produced by the Centers for Disease Control and Prevention (CDC), in consultation with panels of experts and parents, to properly inform vaccinees (or their parents/legal representatives) about the risks and benefits of each vaccine.

Federal law requires that we provide all patients with a Vaccine Information Statement prior to receiving their immunization. We will have physical copies of the VIS available at our clinic to review, but also provide links to them here so you can take the time to read them if you desire.

For more languages and additional resources, please visit immunize.org

Samaritan House San Mateo
Lions Clubs International // District 4-C4
San Mateo County Health
Global Initiative for Health and Wellness