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If you are interested in bringing the mobile clinic to your organization or business, please fill out the form below and click submit. Our Mobile Clinic Coordinator will contact you once your request has been received. Please note that the information asked below must pertain to the facility where the vaccination will take place.

Full Event Address(Required)
MM slash DD slash YYYY
Start Time(Required)
:
MM slash DD slash YYYY
End Time(Required)
:
Contact Name(Required)
Email(Required)
Please select a Service(Required)
Please select which health education topic you will like provided.
Moderna COVID-19 vaccines will be provided.