We've made it easier to partner with us for hosting a clinic for flu & pneumonia shots.

Select a form to register your private (employer/ workplace setting) or public clinic (malls, grocery stores, pharmacies, etc.). Please complete the appropriate form and return it to us by your preferred method of: regular mail, fax: 412-937-8355 or email: info@healthhopenetwork.org

PRIVATE CLINIC REGISTRATION FORM
If you'd like to host a flu shot clinic at your workplace, please complete the form below and return it to us.

PUBLIC CLINIC REGISTRATION FORM
If you have a room to host a clinic at a public location and want to perform a public service to your community while garnering positive publicity for your business or organization, please complete the form below and return to us.

FLU CLINIC CONSENT FORM
Fill out the 2008 Consent Form before attending a flu shot clinic. Take the completed consent form with you to the flu shot clinic near you. A volunteer will verify the information and one of our nurses will give you your shot. Time saving for you & us!