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Clinic FORMS

Print and fill out one screening form and one consent form for each person being immunized.

Bring forms with you to the clinic.

Children & Teens

Screening Form

 

Consent Form

Adults (18 years and older)

Screening Form

 

Consent Form

 

Key Contacts

(608) 266-4821

Wisconsin Immunization Registry
Both the City of Madison and Dane County have adopted policies which prohibit firearms in buildings that they own, lease or control. This includes Public Health offices and clinics.