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Vaccine Forms

Please click the links below to fill out your vaccine form before you come in for a vaccine.

We are able to administer all standard vaccinations to adults, and the influenza vaccine to children age 9 and up, without a prescription. For other pediatric vaccinations, we do require a prescription. Vaccines do not require an appointment; however, feel free to call for information on pricing and insurance coverage.

Consent Form for Flu Shot

Consent Form for Covid-19

Consent Form for All Other Vaccines

HIPAA Card (Must Complete if New Patient)


20% OFF

Your durable medical
equipment purchase!
We are proud to offer this limited time
deal to make your holidays happy and healthy.
Valid from November 24th to December 2nd
This promotion applies to durable medical equipment purchases only, up to $500. No prescriptions, insurance items, or past purchases. Cannot be combined with any other offers. Single-use only. Contact Letourneau’s Pharmacy at 978-475-7779 for details.