Vaccination Clinic Inquiry Form

Company/Community Name:*

Contact Name:*

First NameLast Name

Title: *

Email:*

Phone: (Optional)

Company/Business Type (Select all that apply):*

Clinic location ZIP code*

Street Address

Street Address Line 2

Used to confirm service area and plan clinic logistics.

Who will participate in the clinic?*

Residents onlyStaff OnlyResidents and Staff

Estimated number of participants (residents and staff combined)*

Estimated counts help us confirm clinic readiness and staffing needs.

Vaccines being considered:*

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

Bill prescription insuranceCompany will pay out of pocketUnsure

Medical Insurance Provider:

Example: United Health Care, Medicare Part B, etc

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

YesNoUnsure

Do you have general date or time preferences for the clinic?

YesNo, flexible as part of planning

Which day(s) of the week work best?

What time of day is best?

MorningAfternoonOther

Preferred date ranges or windows (optional)

If helpful, you may share preferred date ranges or windows here. Clinic dates and times are finalized only after clinic readiness and planning are confirmed.

If you have preferred dates or times, you can select them below. Availability may vary, and we’ll confirm details after reviewing your request.

Questions:

Kannon Health Vaccination Clinic Inquiry

Thank you for your interest in our mobile vaccination clinics!

Kannon Health has been serving the greater Austin community and beyond with flu shot clinics and COVID-19 vaccination clinics for many years.

This form is for BUSINESSES/ORGANIZATIONS inquiring about our mobile vaccination services only.

More Information:

Kannon Health is committed to the continued health and wellbeing of the people that live in our long-time home of Austin, Texas. An annual flu vaccine is the best way to reduce the chances that someone will get the seasonal flu virus and spread it to others. Our commitment to the health of our community drives our desire to make access to beneficial vaccinations as convenient and pleasant as possible.

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.

Kannon Health Vaccination Clinic Inquiry

Contact Information

Community & Clinic Basics

Scheduling Preferences (Planning Only)

Additional Notes