Gibbs Pharmacy Vaccine Clinic Interest Form

This form is for businesses/organizations/facilities inquiring about mobile vaccination services only. If you are an individual or family looking to schedule a vaccine appointment, please go to our individual booking site or call the pharmacy at 615-449-3355.

More Information:

We offer mobile flu shot clinics where an immunization certified pharmacist will come to you and administer the vaccine at your place of business. By offering flu shots onsite, your company is ensuring an increased rate of vaccination among your employees while also limiting each employee's exposure to others who may be sick.

COVID-19 vaccines, as well as other routine and travel vaccinations, are available at our clinics as well!

How It Works:

We will schedule a date and time that works best for you and your team. We offer HIPAA-secure, online paperwork that is filled out prior to the clinic to ensure maximum efficiency and to reduce contact. We bill prescription insurance or offer competitive out-of-pocket rates. On the day of the clinic, our immunization certified pharmacist will come to your location and administer the vaccines onsite. We provide all necessary supplies and ensure a clean, safe environment. We also offer other vaccinations in addition to the annual flu vaccine for your convenience!

Company/Business/Facility Name*

Name of Primary Contact*

Primary Contact Title

Contact Email Address*

Contact Phone Number*

Business Address

Where the clinic will be located

Please select which vaccines you would like us to offer*

FluCOVID-19Other

Estimated Number of People to Receive a Vaccine at the Clinic*

Would you like us to bill insurance or will the company pay out of pocket?*

Bill prescription insuranceCompany will pay out of pocketUnsure

Prescription Insurance Provider

Will the company pay for any vaccines that are not covered by insurance?

YesNoUnsure

Which day of the week typically works best for your team?

What time of day is best?

MorningAfternooonOther

If you have a particular date in mind, please select it here. We will try our best to accommodate you based on our schedule.

Date

What time would you like the clinic to start?

Additional Scheduling Notes/Questions