Flu Shot Elsewhere

If you decide to get a flu shot elsewhere than at a UMass Memorial Health entity, you must provide proof of your flu vaccination to Employee Health Services. Here's how:

Proof of Vaccination Information

Proof must include the following information or it will not be accepted. 

• First and last name
• Date of birth
• Date the vaccination was given
• Signature of provider

Submitting Proof of Vaccination

Email the form or use your phone to take a picture of your proof of vaccination documentation, and then email it to:      

• Medical Center: employeeflumailbox@umassmemorial.org
• HealthAlliance-Clinton: HAC_employeehealthservices@umassmemorial.org
• Marlborough Hospital:  medworks@umassmemorial.org
• Harrington: elizabeth.kranz@umassmemorial.org     

Note: We no longer accept faxed flu forms.

Proof of Vaccination Examples

Listed below are acceptable proof of vaccination examples.

• Proof of Vaccination - Example A
• Proof of Vaccination - Example B
• Proof of Vaccination - Example C