School Immunization Form and Consent
Why is it important to immunize? Vaccines protect children and adults against potentially disabling and life-threatening disease. Immunization has saved more than a billion lives and prevented countless illnesses and disabilities. However, vaccine-preventable diseases are still a threat and continue to infect children and adults, resulting in hospitalizations and deaths every year. Take the steps today to help prepare for a healthier tomorrow.
Our office offers the following vaccines: COVID-19, DTaP, Hepatitis A, Hepatitis B, HIB, HPV-9 (Gardasil), Influenza (Flu) - seasonal, MenB (Bexsero), Meningococcal (MCV-4), MMR, Nirsevimab (RSV for infants), Pneumococcal, Polio, RSV (Adult only), Rotavirus, Tdap, Varicella (Chickenpox), Zoster (Shingles)
Visit Immunize.org for more information
Western Plains Public Health can bill the following insurances:
♦ AETNA
♦ Blue Cross Blue Shield
♦ Champ VA
♦ Cigna
♦ Health Partners
♦ Humana
♦ Medica
♦ Medicaid
♦ Medicare
♦ Sanford
♦ Tricare
♦ United Healthcare
If you have an insurance other than what is listed above, WPPH can still provide immunizations. Please note we would collect payment for the cost of vaccine and administration fee at the time of service.
If you are uninsured/underinsured, you may qualify for vaccine assistance. Please contact your local office if you have questions.
3rd Party Authorization to Bill for Services Form
Recommendations & Requirements:
Adult (General Recommendations)
Children (Birth through 6 Years)
Children (7 years through 18 years)
Childcare & School Requirements
Additional Resources:
North Dakota State Immunization Program