Take the flu risk test. Are you:
(check box if answer is yes)

1. Under age 64 with chronic medical conditions?
2. Pregnant, or planning to be pregnant during flu season?
3. A health-care worker?
4. Someone who has regular contact with children younger than 6 months old?

If you answered NO to all these questions you are not at high risk, but should still visit the Student Health Clinic Web site for tips on staying healthy during the cold and flu season.

If you answered YES to any of these questions, the Black Hawk County Department of Public Health strongly recommends you receive a flu vaccination. Please fill in the boxes below and submit.

Name

Phone #

E-mail