Schedule a Group Appointment


Thank you for your interest in a group appointment.
The Shot Nurse will be happy to schedule your group to receive Shot Nurse services at your place of business. Simply fill out the short form below and we will contact you to schedule your appointment.

We are now Blue Cross - Blue Shield & United HealthCare preferred providers!

* All fields are required.


Check here if you wish to file
Blue Cross Blue Shield or
United Healthcare insurance
at your Flu appointment.
We must contact you prior to appointment to verify coverage.
YesNo

Company Name
Contact Name
Address
City
State
Zip Code
Phone
FAX
Email Address

Number of Employees
Number Expected to Participate
Month you prefer
Which Day of the Week do you prefer?
Morning or Afternoon?
AMPM
Is the company paying for the services?
YesNo
How did you hear about The Shot Nurse?
RadioWord of Mouth
MagazineOther

What services are you most interested in?
TravelSchool Shots
Weight LossCompany Inquiry
Lab ServicesB-12 Shots
Lipo ShotsFlu Shots
Other
Comments or Special Requests?