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Vaccinations & Wellness

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Vaccination Clinic Registration

Please complete the form below to register your place of work for a flu clinic.
* Indicates required information
Organization Name * 
Organization Address * 
Contact Person Name * 
Contact Phone * 
Contact Email * 
Contact Person Title 
Contact Mobile 
Contact Fax 
Register my organization for the following services (check all that apply): * 


If Other, please specify:
Tell us about parking accommodations available for the nurse administering the clinic. Include cost details, if appropriate. 
Please indicate how payment will be made. 


If Other, please specify:
Financially Responsible Contact 
Name * 
Phone * 
Email * 
Title 
Address (if different than organization) 
Please indicate preferred days and times for clinic. 




















Questions/Comments 
 

Important Information

  • Influenza vaccination clinics are generally held Monday through Friday, October through January. Saturday and Sunday clinics are available upon request.
  • Clinic times vary between 1 and 4 hours depending on the number of participants. The nurse can administer 20 to 25 vaccinations each hour and the minimum charge is for (20) participants. Friends and family are welcome!
  • Vaccinations can be administered to individuals age 9 and up. Minors require parental consent.
  • Pregnant women in the second and third trimesters can receive a vaccination with a written physician order.
  • Educational and promotional materials will be forwarded to you, along with confirmation of your clinic date and time, once the nurse has been assigned.
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