Vaccine Clinic

Office Hours:     By Appointment Only
                             Mon, Tues, Wed & Fri, 8:00 a.m. - 3:30 p.m.
                             Thurs, 8:00 a.m. - 5:00 p.m.
Location:            3131 O St, 1st Floor, Lincoln, Nebraska 68510
Telephone:         402-441-8065

Please call for more information or to make an appointment.  

Pre-Visit Vaccination Forms

Save time waiting in the clinic! Print, fill out and bring completed forms with you to your appointment. Each person needs a screening form to match the vaccine they will receive. If a child is receiving vaccines without a parent or legal guardian present, please print, fill out & bring a consent form as well. You may fax completed forms to 402-441-8646 before your visit.

AUTHORIZED CONSENT FORMS

English(PDF, 156KB)

Spanish / español(PDF, 72KB)


IMMUNIZATION SCREENING QUESTIONS

Arabic /عربي(PDF, 276KB)

Dari / دری(PDF, 277KB)

English(PDF, 288KB)

Farsi / فارسی(PDF, 227KB)

Karen / ကညီဖိ(PDF, 291KB) (PDF, 291KB)

Pashto / Pəx̌tó(PDF, 221KB)

Spanish / Forma en Español(PDF, 246KB)

Ukrainian / Українська(PDF, 210KB)


IMMUNIZATION SCREENING QUESTIONS - For Children & Teens (Under 19)

لأستمارة(Arabic Minor)(PDF, 263KB)

دری (Dari Minor)(PDF, 281KB)

English(Minor)(PDF, 154KB)

فارسى (Farsi Minor)(PDF, 265KB)

ကညီဖိ (Karen Minor)(PDF, 237KB)

پښتو (Pashto Minor)(PDF, 264KB)

Forma en Español (Spanish Minor)(PDF, 311KB)

Українська (Ukrainian Minor)(PDF, 221KB)


Requirements for Childhood Vaccines

  • Children through 18 years of age and one of the following:
    • Uninsured, Underinsured, Medicaid Covered
    • American Indian or Alaskan Native
  • Must be accompanied by a parent or legal guardian
  • Bring records of previous vaccines

Requirements for Adult Flu Vaccines

  • Low income, uninsured, underinsured adults
  • No adult will be denied service due to the inability to pay

Resources

 

 

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