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Immunization Program Clinic Request
IMMUNIZATION PROGRAM CLINIC REQUEST FORM
Please select if this request is for a COMMUNITY Clinic or CORPORATE Clinic:
Community Clinic Examples: Church, Senior Center, Assisted Living Facility, School, etc.
Corporate Clinic Examples: Business interested in providing vaccines to employees
You will recieve a confirmation email once your request is submitted. If you do not, please contact MC VNA: 1-800-852-1232