On-site COVID-19 Testing Clinic

On-Site Flu & COVID-19 Vaccine Clinic Inquiry

Once we receive the filled form, we will contact you shortly to confirm availability.
For on-site flu and COVID-19 vaccine clinics, there is a minimum requirement of 10 vaccinations (including flu and COVID) per clinic.

Most insurances cover the cost of the flu vaccine completely with $0 copay. Patients with Kaiser and Hawaii Laborers insurance plans will have a small cash price of $35.
Business Name*
Point of Contact Full Name*

First NameLast Name
E-mail*
example@example.com
Phone Number*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Estimated Number of Individuals Needing Vaccinations*
Preferred Day of Week - 1st Choice*
Preferred Day of Week - 2nd Choice*
Preferred Time of Day*
Are you interested in on-site COVID-19 vaccinations?*
Which COVID-19 vaccines are you interested in?

ModernaPfizerJ&JNovavax
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On-Site Flu & COVID-19 Vaccine Clinic Inquiry