RTCPeds Flu Shot Clinic Appointment Request

RTC Pediatric Flu Shot Clinic Appointment Request.

This clinic is for existing patients 6 months and older. Please have your child wear a short sleeve shirt. For babies, please have them wear easy to remove clothing.
RTC Peds has Flu Shots! Until we schedule additional clinic slots, please fill out the form below to request a Flu Shot appointment. You will be called at the phone number you provide. You may also contact the Front Desk Staff at 703-435-3636 for a Flu Shot appointment.

Thank you for your patience.
Your Child(ren) need to be free of illness to receive the Flu Shot: no runny nose, cough, fever within 24 hours of Flu Clinic Appointment.
Child's Name:*

First NameLast Name
Child's DOB:*

MonthDayYear
Date
Parent/Guardian Name:*

First NameLast Name
Phone Number*
E-mail*
example@example.com
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