On-Site Event Request

On-Site Flu Shot Request

  • Preferred On-Site Date & Start Time

    Flu shots are available for participants 18 yrs. of age and older

  • (mm/dd/yyyy)
  • (mm/dd/yyyy)
  • (mm/dd/yyyy)
  • Preservative Free vaccine for pregnant or nursing mothers only.

    Each "Preservative Free" shot will incur an additional $5 charge.

  • Eligible Participants (check all that apply):
  • If you are requesting service for multiple offices/times, please complete a reservation request for each.

  • An on-site nursing fee of $75 per hour is charged for times scheduled before 7:30 am or after 4:30 pm, on weekends, if there are less than 20 participants per hour, and/or when the event takes place outside a 30 mile radius of 63127.

  • Payment:

    All charges will be Master Billed to the Company, and are due within 30 days of receipt. (no insurance billing)