• 2026 Flu Clinic Request Form

    Please fill out this form to submit a request for an onsite flu clinic.

  • Flu Clinic Pricing

    Click Here for pricing details within the D.C. Metro area.

    *If you are outside of D.C., Maryland, and Virgina please email Info@LifeWorkStrategies.com

  • Terms and Conditions:

    • The earliest request date for the 2026 flu season is September 14th. 
    • Requests should be submitted four (4) weeks prior to the requested clinic date.
    • To provide confirmation in a timely manner, we ask that you provide three (3) potential dates and times for your clinic. One of the three (3) dates provided will be confirmed.
    • There is a 2 hour minimum for the duration of the requested clinic.
    • There is a 30 vaccination minimum.
    • Once your clinic has been staffed, you will receive an email, confirming the date, time and staff for your flu clinic.
    • Date or time changes that occur within two weeks of the confirmed clinic date, will be subject to a $250 fee. Cancellation terms and fees are outlined in the program services agreement.

  • Company Information

  • Is your Billing Contact different than the Point of Contact provided above?*

  • Requested Clinic Information

    Please provide (3) three potential dates and times for your requested clinic. We will work to fufill your request based on the order they are provided below. 

  • 1st Request Date *
     - -
    2 digit month, 2 digit day, 4 digit year
  • Time of Requested Clinic*
    Until
  • 2nd Request Date *
     - -
    2 digit month, 2 digit day, 4 digit year
  • Time of Requested Clinic*
    Until
  • 3rd Request Date *
     - -
    2 digit month, 2 digit day, 4 digit year
  • Time of Requested Clinic*
    Until

  • Additional Information

  • Is your flu clinic part of a larger event such as a health fair?*
  • Are any of the participants at your clinic under the age of 18?*
  • Do you have any parking and/or security information specific to the clinic location?*
  • Should be Empty: