Flu Clinic Details WA

Flu Clinic Details

id

date time

Company Name

Location Name

Address

Suburb

State

Postcode

Contact Details

First Name

Last Name

Phone Number

Mobile Number

Email

Flu Clinic Details

Total number of staff at this location?

Estimated number of vaccines needed?

What room will the clinic be held in?

How many clinics will you need at this location?

Please indicate the days which are suitable for your clinic

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday (additional fees apply)

Sunday (additional fees apply)

Is this clinic able to be held during school holidays?

No

Yes

Appointment Booking

Manual

Online

Is carparking provided for the nurse?

Yes

No (please use nearby paid parking and invoice us)

No (free street parking is available)

Is there any other information that would assist us to arrange your clinic? Particular dates or specific days/times.

*We will endeavour to match your preferred requests, but please note this is not always possible due to high demand.

T & C's

Cancellation of our service from this point forward will incur a cancellation charge of 50% of the total estimated cost.

I agree