Mobile Vaccination Clinic Request
The Indiana Immunization Coalition has a direct service mobile vaccination team. We are offering these on-site services throughout Indiana. (Clinics are set up in your space, we do not have a portable vaccination vehicle at this time) For more information click here: http://bit.ly/mobilevaccines

Below you can request locations where you would like a mobile vaccination clinic.

PLEASE NOTE: You should make your clinic request 3-4 weeks before the desired clinic date. This allows us time to gather necessary supplies and coordinate staff. Clinics are scheduled on a first come, first serve basis and dates fill up fast!
Email address *
Contact Name *
Contact Phone *
Location Name *
Location Address *
Type of Location / Population (check all that apply) *
Required
Are you requesting ONLY flu shots? *
Special considerations
A copy of your responses will be emailed to the address you provided.
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