Please fill out the information below to register for your 2021 flu shot with Passport Health!

The online sign-up will be available until 48 hours before the clinic. In order to maintain social distancing and to better protect you and our staff, online registration is mandatory.
We cannot guarantee vaccine availability or insurance coverage for those who do not sign up in advance.

Sign-ups are taken in 15-minute intervals. If a date or time is no longer listed, that time slot has filled.

Clinic Location
First Name
Last Name
Date of Birth
Confirm Email
Mobile Phone Number
Insurance Billing Information
Provider Name
Member ID
Group ID
Insured through
Spouse / Domestic Partner
Services I'd like to receive
You will receive those immunizations as medically indicated by your health consultant staff. Vaccine Information Statements are available online here.

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