Skippack Pharmacy Mobile Vaccination Clinic

Skippack Pharmacy Mobile Vaccination Clinic

Bring vaccines directly to your workplace, school, church, or community event. Complete this quick form and our team will help coordinate a mobile clinic date, vaccine options, and a seamless on-site experience for your group.
This form is for ORGANIZATIONS inquiring about our mobile vaccination services only. If you are an individual looking to receive a vaccine please refer to our website for upcoming community vaccination events near you. You can also sign up for a vaccination at Skippack Pharmacy on our website or walk in today!
How it works:

After willing out this Skippack Pharmacy Mobile Vaccination Clinic interest form, our team will schedule a date and time that works best for you and your team. A HIPAA-secure, online consent and sign-up form will be sent to you via email. It should be filled out by your team members who want a vaccine prior to the clinic. This allows us to obtain the information of each individual who will be receiving a vaccine. Then we can bill insurance and solve any issues ahead of time. On the day of the clinic, our immunization certified team members will come to your location and administer the vaccines onsite. We provide all necessary supplies and ensure a clean, safe environment.
We will hold vaccination clinics for businesses, long term care facilities, schools, churches, neighborhoods, at community events, etc! The company has the option to open the vaccination clinic up to family members, other businesses or the community if they choose. Please fill out the form below and a member of our team will be in touch with you shortly!
Company, Group, Community or Organization Name*
Name of Primary Contact*

First NameLast Name
Primary Contact Title
Contact Email Address*
example@example.com
Contact Phone Number*

Area CodePhone Number
How did you hear about us?
What is the best way to contact you?
Clinic Address (where the clinic will be located)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
FluCOVID-19Tdap (Tetanus, Diptheria, and Pertussis)Pneumonia (50 and older)Shingles (50 and older)RSV (50 and older)Other
Estimated number of people to receive a vaccine at the clinic*
Bill the vaccines the person's insuranceCompany/organization will pay out of pocketUnsure
MondayTuesdayWednesdayThursdayFridaySaturdaySundayNo Preference
Morning (Earliest Start Time = 10am)Afternoon (Latest End Time = 6 pm)Other
Please list any dates that you would be interested in having the vaccine clinic on.
What time would you like to start the clinic (between 10 am and 6 pm)?

:HourMinutesAM/PM Option
Additional Notes
What specific questions do you have for us?
Should be Empty: