1. Online Order Form
Please complete the form below to reserve your flu vaccine. A Nationwide Medical team member will contact you shortly to confirm your order.
[contact-form-7 id=”523″ title=”Online Order Form”]
2. Call Us!
Toll Free: (800) 997-8846
Phone: (818) 997-8848
Fax: (818) 997-8850
Complete form and fax it to:
Or scan and email it to:
To order Tamiflu, please download and fax the form below:
Order Form (.pdf)
1. Complete and sign the order form
2. Fax completed form to (818) 997-8850
To view PDFs, download the free Adobe Acrobat® Reader.