Housatonic Valley Health District is providing full-time public health services to all the citizens of our member communities. We are offering a new program for people with on-going health conditions which is designed to complement the care that people receive from their health care providers. Our focus is to provide essential programs to  assure our residents of a healthy community environment, aid in preventing disease, and promote health through screening, and health education.

Community Health Forms

View/download the HVHD Community Health forms. 

Form Title	Description	Download/View Form
Flu Vaccine Consent Form	Complete this form to receive your annual flu vaccine	Download
CT Vaccine Program Eligibility Form	Complete this form for child who qualifies for immunization through the Connecticut Vaccine Program since they are under 19 years of age and qualify for one option as listed within the form	Download
Unaccompanied Minor Consent Form	Complete this form for unaccompanied minors consenting that they can receive a vaccine from HVHD	Download
Foodborne Illness Incident Report	Complete this web-based form to report a foodborne illness	Web Form

Program Supervisor

Meet your HVHD Immunization Program Supervisor.

Updated: September 19, 2023