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Germ Guy
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Germ Guy

Clinic Information Form


If you would like to add, remove or edit your clinic information to the list of locations where vaccines are administered, please fill out the form below. A representative will contact you in 5 to 7 business days to confirm your listing on Vaccines411.

All fields marked with a * are required

 

   
 
   
 

 
Other, please specify:

* Please select all vaccines that you administer at your clinic/office.

 
Other , please specify:

* Do you have a minimum age requirement?
   
 

* Do you offer online appointment bookings?
   
 

* Do you offer COVID-19 testing?
   
 

* Do you offer on-site vaccination services to businesses, schools, homes or other locations?
*Please note that if you click yes to on-site vaccination, we will follow-up shortly by phone for more information.
   
 

Special Instructions or Notes
August 2023