Book a Flu Clinic
Clinic Set Up Details
Facility must have at least 10 patients to request a clinic. Pharmacists can administer approximately 40 vaccines per hour.
Contact Information
Name of Facility
Address of Facility
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Contact Person
Phone Number
Please enter a valid phone number.
Email
example@example.com
Best method for contacting you?
Please Select
Email
Phone
Have we done a clinic for this facility before?
Please Select
Yes
No
Will our pharmacist be moving from room to room or in a central location?
Please Select
Central Location
Room to Room
What vaccines is the facility interested in us bringing?
Flu Vaccines for under 65
Flu Vaccines for over 65
Covid Booster
How many flu vaccines do you anticipate us administering?
Please Select
10-20
20-30
30-40
40-50
50-60
60-70
70+
Will there be any self-pay patients? Self pay price for regular/young adult flu shots is $60 Self pay price for high dose flu shots is $78.
Please Select
Yes
No
How will those patients pay?
Please Select
Check
Credit Card
Exact Change
Invoice Us
How would the facility like to receive consent forms?
Fax a copy
Email a copy
Receive a digital copy to fill out online
Flu Clinic Schedule
*
How will we gather insurance information?
Please Select
Facility will provide insurance
Take pictures
Something else noted below
Additional notes:
Submit
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