Request Scheduling
We offer flu shot clinics of all sizes for a variety of businesses, schools, churches, assisted living facilities, and other communities and offices! Please fill out the form below and a member of our team will be in touch with you shortly!
Name of Business
*
First Name
Last Name
Name of Primary Contact
*
First Name
Last Name
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Estimated Number of Employees to Receive Vaccination
*
Would you like us to bill insurance or pay out of pocket?
*
Please Select
Bill insurance
Pay out of pocket
Which day or the week works best for your staff?
*
Please Select
Monday
Tuesday
Wednesday
Thursday
Friday
What time of the day works best?
*
Please Select
Morning
Afternoon
Any time
Submit
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