PacRim will host an onsite flu clinic on Thursday, September 12, after chapel. Please sign up below, so we can have as accurate of a headcount as possible to help ensure everyone can be serviced!

A Longs Drugs pharmacist will be coming to our office to administer flu shots to anyone who is interested. In addition to the flu shot, there are other vaccines available to help protect us from illness.

In most cases, the vaccinations are absolutely free through insurance (all except Kaiser).

You will also receive a $5 off $25 purchase Longs coupon.

If you are interested in receiving vaccination(s), please fill out and submit the form below.

CONTACT INFO
Name *
Name
Date of Birth *
Date of Birth
Phone *
Phone
VACCINATION(S) REQUEST
I am interested in receiving a vaccine to prevent (check all that apply): *
INSURANCE INFO
If you do not have insurance, state 'NONE' in the remaining blanks.