#flUGA Clinic Request

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Please use this form to request a #flUGA clinic for your group. Once we receive your form, someone will be in touch to confirm.

Name

Phone Number

How many people do you anticipate at your event?

Location of event

Proposed Date

Time of event

Backup Date

Backup time of event

Do you have a space where vaccines can be administered?

Additional Comments

Notice: Health Center Closure