Flu Vaccination Request Form 

For Friend of the Foundation and Circle of Excellence Members with Munson Healthcare Foundations

COVID-19 cases are currently on the rise in northern Michigan. Due to visitor restrictions in place at our hospitals, along with added staffing challenges, we are working to limit the number of visitors at all Munson Healthcare facilities. 

If you are able, we encourage you to receive this year's flu shot outside of Munson Healthcare. These vaccinations are typically available at low or no cost through your primary care provider's office, local pharmacies, and many stores within your community.

If you cannot obtain a flu vaccination elsewhere, please complete the following form by October 1, 2021. A Foundation staff member will contact you in early October to help coordinate your flu vaccination.