Mobile Clinic Event Request Form

*Please give 30 days advance notice.

Contact Fax

* We are Texas Vaccines for Children providers. For questions on eligibility, please call 832-824-6788.

Must be clear of low hanging wires and trees, steep inclines, and fire lanes/zones.

PLEASE NOTE: We carefully consider all requests submitted throughout the year. Requests for the months of July and August will be reviewed after March 15th.   Please keep in mind that early submissions do not always guarantee acceptance.

How will you promote the event? (mark all that apply) *