Flu Clinic Booking Form - Harbour Healthcare

In which State or Territory will this clinic be held?*
- Australian Capital Territory
- New South Wales
- Northern Terrirory
- Queensland
- South Australia
- Tasmania
- Victoria
- Western Australia
Company Name*
Location Name
This is required for clients who have multiple sites
Address for this clinic*
Street Address Building Name and/or Floor/Unit Number City State/Territory Postcode
Site Contact Person*
First Last
Phone Number (office)*
Phone Number (mobile)
Email*

How many clinics will you need at this location?*
Please enter a number from 1 to 9.
Please note that additional charges apply for locations where more than one clinic is requested
How many staff work at this location?*
How many staff are you expecting to get vaccinated at this location?*
Please note that the number of staff being vaccinated will determine the length of your clinic. We allow 15 minutes for every 8 people (minimum clinic length is 30 minutes). HHC recommends that unless you have data from past clinics, you should estimate that 35% of staff will get vaccinated.
Your participation rate (%) is estimated to be:
Where will the clinic be held?
eg meeting room, first aid room, board room
What type of appointment system would you like?*
- Online
- Manual
Our online booking system is a great option for staff who have access to computers, but in many workplaces, staff are mobile and don’t have ready access to a computer. In these circumstances, a manual booking system is a great alternative where a staff can simply put their name on a manual booking sheet.
Do you have reliable mobile internet coverage?*
- Yes
- No - but we can provide access to our wifi network
Our nurses require reliable mobile internet coverage to use our online system. If you do not have reliable coverage or cannot provide access to a Wifi network please notify us