The State of New Hampshire will be providing the H1N1 vaccine free of charge to all state residents 6 months of age and older who wish to be vaccinated. We will not be getting any more H1N1 vaccine for children under the age of 36mths.  The vaccine will be distributed according to very specific guidelines and therefore not everyone will be eligible to receive the vaccine at the same time.

If you are interested in receiving the H1N1 vaccine, please fill out the information below and you will be contacted when it is available.
 
If you have an allergy to eggs or the preservative Thimerosol, you will NOT be eligible to receive the vaccine.

H1N1 VACCINE REGISTRATION FORM

Flu Shot FAQ's

*Name of person requiring vaccine:

Name of person
filling out registration:
(if different than above)

*Phone Number:

*Age:

Relationship:

*E-mail Address:

Please check off the appropriate box that applies to you:

 

*DOB:

Asthma

Wheezing in the last 12 months

*Required field

Information
on  the
Swine Flu