Flu Shot Sign Up Form
Fill out the required information to ensure your family gets their flu shots given in the home. Free with proof of insurance. $25 cash/debit/check due at the visit
Primary Contact's Name
Your answer
Contact's Phone Number
Your answer
Contact's Email
Your answer
How many people 3-65 years of age will be getting a flu shot by Table Rock?
*Visits must consist of 2 or more people
How many children 6-36 months old will be getting a flu shot by Table Rock?
*Visits must consist of 2 or more people
Street Address
*This is the location where the visit would take place
Your answer
City
*This is the location where the visit would take place. Must be located within Boise, Garden City, Eagle, Meridian, Kuna, Nampa, Caldwell, Middleton or Star.
Your answer
Zip Code
Your answer
Preferred method of confirming appointment
Type of Payment?
Required
Once you hit submit, Table Rock Mobile Medicine will contact you to confirm your request.
All information provided in this form is secure and kept private. None of the information will be used for anything other than improving your health. If you are having a medical emergency, do not wait for us to contact you. Pick up the phone and dial 911 or go to your nearest emergency room. We thank you for your business.
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