Worksite Flu Immunization Clinics


CNS offers mobile flu clinics for businesses and other organizations from September through November, often at no cost to the businesses themselves. CNS will bill individual insurance providers or accept payment from individuals or businesses.

Schedule your on-site employee immunization flu clinic today!

  1. Please download/save this blank form. (you must save the form to your computer before you fill in any of your information)

  2. Fill out the form and click “File” then “Save As” & save this form with your company’s name.

  3. Email your completed form to or print & fax to (801) 207-8776.

  4. If you are unable to fill out the electronic form you can call us to schedule your school’s clinic at (801) 207-8777 

*You will be sent a confirmation within 48 hours once your form has been is received.