Pharmacy Residency (PGY1)
Post Natal Nurse Home Visitor Program

Mobile Immunization Van Application

Note: ⏳To help us plan effectively and ensure the best experience possible, please submit your request at least six to eight weeks before your event date. This allows our team time to review, coordinate internally, and determine how we can best support your event.

If you would like to request additional Parkland education and resources at your event, please visit our community health fair page.

*indicates required field

Please review the eligibility criteria on the Mobile Immunization webpage before submitting your request. Flu vaccination requests are accepted during flu season only. Incomplete forms may delay review. Please be prepared to provide promotional materials with your submission.

Contact Information


*

Event Details


* Event Date
Requests will be fulfilled based on available resources. Please allow six weeks' notice to ensure availability.
*








Parking Details


*





Immunization Request



Additional Information
















CAPTCHA