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Vaccine Registration Page (Organization)
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Vaccine Registration Page (Organization)
You may complete your registration by fulfilling and submitting the following form
You may opt for a discovery call instead by clicking on the widget at the bottom right
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Please enable JavaScript in your browser to complete this form.
Organization Name
Point of Contact
Email
*
Phone Number
Preferred Location for Services
On-site at your premises
Off-site at MedsPLUS clinic
Other (please specify)
What service(s) are you requesting? (Check all that apply)
Vaccination programs
Health screenings (e.g., blood pressure, glucose)
Wellness workshops
Chronic disease management sessions
For vaccinations, which type(s) do you require? (Check all that apply)
Vaccination programs
Health screenings (e.g., blood pressure, glucose)
Wellness workshops
Chronic disease management sessions
Flu
COVID-19
Shingles
RSV
Pneumonia
Tdap (Tetanus, Diphtheria, Pertussis)
HPV (Human Papillomavirus)
Meningococcal
Estimated Date or Timeframe for the Program
Are there any special considerations or requirements we should know about?
Expected Number of Participants
Selected Value:
0
Preferred Schedule
Morning
Afternoon
Whole day
Do you require employee registration assistance?
Yes
No
Communication Preferences
*
By checking this box, I consent to receive conversational, marketing, and customer care SMS from MedsPLUS Pharmacy & Wellness Center. Reply STOP to opt-out; Reply HELP for support; Message & data rates may apply; Messaging frequency may vary. Visit
Privacy Policy
to see our privacy policy and
Terms
for our Terms of Service.
By providing your phone number, you consent to receive text messages (including automated messages) from MedsPLUS regarding your account, services, and updates relevant to you. For full details on how we collect, use, and protect your information, please review our Terms and Conditions and Privacy Policy found below the submit button.
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