Schedule Your Organization

Business Aids: Workplace Planning and ADA Questions

Thank you for choosing Prevention MD to provide your company or organization with flu vaccinations. We are currently scheduling seasonal flu clinics.

The cost for the flu shot is $30 per individual. We require an average minimum of 15 participants per hour per nurse. An additional nurse's fee of $75.00/hour will be charged for any hour(s) causing the average to fall below 15 participants/hour/nurse (If # of total participants=35 utilizing 1 nurse; no nurse's charge for 1 hour or 2 hours, but there would be a $75 charge for each hour the nurse stayed beyond 2 hours - assuming 35 to be the final total). Please call (800-346-4915) if you have any questions. A printout on the benefits of providing flu shots to your company or organization is available: Flu Shot Benefits. To schedule your company, please provide the following information for each location.

Use valid email address / phone number formats (e.g. name@server.com / 000-000-0000).
All fields required. May use n/a or 000-000-0000 or email@email.com for non-entries.

Company Name, Address, Phone, and Fax:
Contact Person:
Direct Phone Line:
Cell/After Hours Phone:
Email:
Alternate Contact Person:
Direct Phone Line:
Cell/After Hours Phone:
Email:
Billing Information (if different from above) Contact Name, Billing Address, Phone, and Fax:
Approximate number of flu vaccinations:
Please select payment option:
Please specify your normal work week and hours of your work day:
Please specify the times of any shift changes we need to cover:
Please specify any dates, days or times that DO NOT WORK for you:
Please specify any special instructions or comments:
Please select payment option for nurse's parking:
How did you find you about us?
Have you read and do you agree to the terms at the top of the page?	Yes No
Would you be interested in information on our CPR, First Aid, AED or Travel Medicine services?	Yes No
Please contact me about the 20% Discount Package for CPR/First Aid Training?	Yes No
Our nurse will require a table and two chairs at the vaccination site. To expedite service, please notify your employees as to the date and time allotted for service. We like to take up as little of your company time as possible.