Worksite Flu Shot Request

Thank you for your interest in our onsite flu shot clinics. We offer the standard quadrivalent influenza vaccine, which is approved for use in persons aged 6 months and older (please note that our clinics only vaccinate persons aged 9 years and older). We will invoice your organization for the cost of influenza vaccine, staffing and mileage.

To request a clinic, please submit this form and someone from our office will follow-up with you. Questions? Please email [email protected]

* Asterisk indicates required field.

Today's Date
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Flu Shot Information
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Please provide an exact number or an approximate range. If we did a flu shot clinic for you last year and believe the same number of people will attend, indicate that here.
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Please call 911 if you have an emergency or urgent medical question.

Already a Henry Ford patient?
For the best experience, existing Henry Ford patients can request and self-schedule appointments through Henry Ford MyChart.

Henry Ford Health is committed to ensuring our Deaf or hard-of-hearing patients and visitors have equal access to all services. We provide the appropriate auxiliary aids and services, including qualified sign language interpreters, TTYs and other assistive listening devices, at no cost. To request assistance, call 313-916-1896 or email [email protected].

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