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We have made the CDC Immunization Schedules available for you in the menu at the far right.  You can look up the recommendations by age group.


As of June 2016, our immunization clinic is open by appointment only. New patients will need to pre-register at least 72 hours prior to the appointment by submitting their intake forms, immunization records (for patients 18 and under), and a front-and-back copy of their insurance card(s) if applicable. 


Please choose one of the following ways to submit your information.

By Mail: 

Jefferson County Health Department – Immunization Office
1948 Wiltshire Road, Suite 1
Kearneysville, WV, 25430

In Person:

At the above address between 8:30am & 4:30pm, Monday-Friday

By Fax:

304-728-3319 – Attention Immunization Office

By Email:

JeffersonLHD@wv.gov – patient name as subject.

Select from the following forms:

Vaccines for adults and children (please print this form double-sided if possible):
Immunization Intake Form

Immunizations for patients 18 and under (must bring up-to-date shot record):
Vaccines for Children Program Patient Eligibility Screening

TB tests and screening letters:
Tuberculosis Risk Assessment – English
Tuberculosis Risk Assessment – Spanish

Seasonal Influenza Vaccination Consent/Administration Form
Click here to download the form

New Family Planning patients (Medicaid patients must bring card):
Family Planning Program Basic Data

To send medical records to another healthcare provider:

Authorization to Release or Obtain PHI

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