On-Site Vaccination Request
Convenient and professional on-site vaccination offered at no charge to groups of 20 or more individuals. Most insurance plans cover vaccines for a $0 copay.
Site Name
Company or Organization Name
Contact Name
First Name
Last Name
Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
example@example.com
What types of vaccines would you to offer? (Check all that apply)
Flu
COVID-19
Shingles
RSV
Other
Address where you'd like vaccines offered:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
We bill participant's pharmacy insurance for the cost of the vaccine and usually there is no copay, but if you're a self funded employer we do offer volume discounts.
Please bill participant's insurance
We'd like to learn more about volume discounts for self-funded employers
Would your organization would like to cover the cost for uninsured participants?
No, refer uninsured to their primary care provider
Yes, please bill us for vaccines for uninsured participants
What days of the week, time of day or specific dates work best for you?
Someone will reach out to you within 1-2 business days to answer any questions you have and get you scheduled. Please share any additional questions or requests you have here:
Submit
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