start planning a clinic
Start a conversation—no obligation
Share a few details below to get started. This form is intended to help us understand your setting and needs. it does not commit you to scheduling a clinic.
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We’ll follow up with helpful information and outline next steps based on what you shared.
Information we'll ask for
To keep things simple, we’ll ask for a few basic details, such as:
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Community or organization name and location
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A primary contact
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The population you serve
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An approximate number of people interested
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Preferred timing, if known
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You don’t need to have everything finalized to submit the form.
What happens after you submit the form
​Once we receive your inquiry:
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​We look over the information you’ve shared to understand your setting and needs
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We follow up to clarify details or answer any questions
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We outline next steps based on your timing, population, and location
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Follow-up is typically handled by email, with virtual or phone conversations available when helpful.
What this form is
(and isn’t)
This form is for:
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Exploring whether an on-site vaccination clinic may be a good fit
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Asking questions about timing, logistics, vaccines, and billing
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Understanding what hosting a clinic would look like
This form is not:
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​A commitment to schedule a clinic
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A medical consultation
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A guarantee of pricing, coverage, or vaccine availability