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KidsCare Link physician & office staff registration form

is this a request for a provider or for a delegate?

access information

requester information

(you must enter a business email address. If you do not have one, please enter your manager’s business email address. We cannot accept Yahoo, Hotmail, Gmail or other private email accounts. This is a REQUIRED field.)

clinic location information

get your flu shot by Halloween

The key is to get the vaccine at least two to three weeks before the flu season begins in order to have optimal protection against it. 

learn more