Consent to Treat for Immunizations
The Immunization Consent Form for Children and the HIPAA Consent Form must be completed by the parent or legal guardian if a friend or family member will be bringing your child for their immunization appointment with the Seneca County General Health District.
Immunization Consent Form for Children
Send the completed forms, a current shot record and health insurance card(s) with the adult that is bringing your child to the appointment.
For all other nursing services (e.g. TB testing, lead testing, head lice check) please download and complete the following forms
Consent for Care and Release of Information
Send the completed forms and health insurance card(s) with the adult that is bringing your child.
Department Info
71 South Washington Street
Suite 1102
Tiffin, OH 44883
(419) 447-3691 ext. 333
Contact
Nursing Division
Seneca County General Health District
Suite 1102
Tiffin, OH 44883
Hours of Operation
Monday - Friday
8:00 AM - 4:00 PM
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