Request a Flu Shot Clinic


To request a flu shot clinic at your workplace, please complete the following informational form. A clinic coordinator will contact you to discuss the details. Or, you can contact a flu shot coordinator by phone.

I am interested in offering:  

Flu shots
Pneumonia vaccine
Community wellness programs
I am in the following county:  
Company name:  
Contact name:  
Phone number:  
E-mail address:  
Street address:  
City:  
State:  
Zip Code:  
Number of employees:  
Preferred dates:  
Additional information: