• DeKalb County Board of Health
    Mobile Flu Vaccination Clinic Request Form

    Thank you for your interest in helping get people vaccinated. Please complete this form if you are interested in hosting a mobile flu vaccination clinic at your organization. Host organizations must be in DeKalb County, Georgia, and include places of worship, nonprofits, businesses, schools, and community organizations. Completing this form is the first step to notify us of your interest, but it does not guarantee that we will fulfill your request.

     

    If you need help with this form, please email don.brundage@dph.ga.gov
    or alina.matthew@dph.ga.gov.

    *=questions that are required

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  • Once submitted, please print out one of the forms on the following page, fill it out and bring it with you during your mobile flu vaccine clinic appointment.

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