B2B Vaccination Clinic
Hawthorne Pharmacy is a locally owned and operated, independent pharmacy with eight locations in the Midlands. This form is for businesses that are interested in setting up vaccination clinics for their employees and/or patients. Vaccines can be administered at our location but we may also be able to set up a clinic at your worksite depending on the information provided.
Name of Business
*
Describe the type of business/workplace
Number of Employees / Patients
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
First Name
Last Name
Contact E-mail
*
example@example.com
Contact Phone Number
*
-
Area Code
Phone Number
Comments:
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