Vaccination Appointment Request

To request a vaccination appointment, please fill out this form or give us a call during our business hours. Please do not provide any medical information in this form. No fees are charged for flu shots. All other vaccinations are available for a $20 fee.

Phone: (705) 222-2200
Fax: (705) 419-2410

Monday to Friday: 9am to 6pm
Saturday: 10am to 4pm
Closed Sundays & Holidays

Vaccination Request Form

Name

First Name

Last Name

Phone

(###)

###

####

Email

Required Vaccine

No fees are charged for flu shots. All other vaccinations are available for a $20 fee. COVID-19 vaccines are not currently available.

Preferred Appointment Time

We will call you to book a specific appointment time.

Weekday Morning

Weekday Afternoon

Weekday After Work

Saturday Morning

Saturday Afternoon

vaccination appointments

Vaccination Appointment Request

Vaccination Request Form