Home Health Care 831-372-6668 Hospice 831-751-5500 Travel Immunizations 831-648-3777

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Immunization Clinic Registration

Name of Organization*
Organization Type*
Billing Address*
Street Address City State ZIP Code
Primary Contact Person*
Contact Email*
Contact Phone*
Contact Fax
Alternate Contact Person
Alternate Email
Alternate Phone
Please indicate how payment will be made*
- Company Pay (company receives invoice after clinic)
- Self Pay (Cash or Check made payable to VNA Community Services)
- Medicare Part B (no charge; patient must present card at time of vaccination)
Payment Instructions
Are you interested in other immunization services?
- Tdap (tetanus, diphtheria, pertussis - whooping cough)
- Pneumonia
- Shingles
- TB Skin Tests
- Wellness Screenings
- Other
Other, please specify
# of Clinics to Schedule*
Clinic Site #1
Clinic Address*
Use billing address?
Street Address City State ZIP Code
Number of people at location
Approximate number to receive immunizations*
Preferred Clinic Date*
Date Format: MM slash DD slash YYYY
Start Time*
: HH
MM
End Time*
: HH
MM
Alternate Date/Time
Alternate Clinic Date
Date Format: MM slash DD slash YYYY
Start Time
: HH
MM
End Time
: HH
MM
Parking instructions
Clinic location within building
Comments/Questions
Would you like to schedule an additional on-site clinic?
- Yes
- No
Additional clinic site
Clinic location
Use billing address?
City State ZIP Code
Number of people at location
Approximate number to receive shots*
Preferred Clinic Date*
Date Format: MM slash DD slash YYYY
Start Time*
: HH
MM
End Time*
: HH
MM
Alternate Clinic Date
Date Format: MM slash DD slash YYYY
Start Time
: HH
MM
End Time
: HH
MM
Parking instructions
Clinic location within building
Additional notes (optional)
Comments
This field is for validation purposes and should be left unchanged.

ACCREDITATIONS & AFFILIATIONS

SUPPORT VNA

The VNA & Hospice is a local charitable organization providing skilled home health care and community services to the local residents of the Central Coast. Your donation assists in providing the best care for your neighbors.

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Home Health Care

Our VNA Home Care Services are provided by a trained and certified staff to assist patients in the comfort and familiarity of their own homes.

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Hospice Care

VNA & Hospice Care offers a multi-discipline team approach to provide patients with dignity, support and illness management in their own home setting.

More Information

P.O. Box 2480
Monterey, CA 93942

5 Lower Ragsdale Dr
Monterey, CA 93940

Tel: 831-372-6668
Fax: 831-648-7726

Home Healthcare & Hospice Inquiry/Referral
831-375-9882

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URGENT UPDATES

As the leading home-based care provider and community immunizer, VNA puts the well-being and health of our community first and foremost. Based on recommendation of California Department of Public Health, VNA will postpone the Speaker Series on Thursday, March 19, 2020 and Lobster Feast scheduled for Sunday, March 22, 2020. We will reschedule at a later date and all reservations will be honored.

As a community, we cherish every opportunity to come together and look forward to the future opportunities. Further information and rescheduling these events will be forthcoming from our development department.