Occupational Health - Greenwich Hospital

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5 Perryridge Road, Greenwich, CT 06830
Main Phone Number: (203) 863–3000

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Occupational Health Services 2008 Flu Vaccination Program

To register for, or inquire about, a work-site influenza vaccination program at your place of business, please provide us with the following information.

Name:
Company:
Address:
City:	St.: Zip:
Email Address (required):
Alternate Contact:
Phone:
The 2008 Flu Vaccination Program is available from October 1, 2008 until December 12, 2008, Monday – Friday, times to be arranged
Please list 3 date preferences: Date: AM PM Date: AM PM Date: AM PM
# of Employees in Company:
# of Employees Expected to Paticipate:
Yes, my company is interested in an on-site flu program Our Company will pay for the immunizations Our employees will pay at the time of service Please send more information about other Occupational Health Services

Or, print out and return to: AMY COSTA, PROGRAM COORDINATOR OCCUPATIONAL HEALTH SERVICES 75 HOLLY HILL LANE, LEVEL C GREENWICH, CT 06830 (T) 203 863-3753 Or fax to: 203 863-3495 Confirmation dates sent via e-mail within 7-10 business days.