GU Health Onsite Flu Clinic Booking -

In which State or Territory will this clinic be held?*
- Australian Capital Territory
- New South Wales
- Northern Territory
- Queensland
- South Australia
- Tasmania
- Victoria
- Western Australia
- New Zealand
Please note that each site/office/business will require a new form.
Company Name*

Please enter the name of the company i.e Acme Pty Ltd
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

What is the name of the site contact
Phone Number (office)*
Phone Number (mobile)
Email*

How many clinics will you need at this location?*

Please enter a value between 1 and 9.

Please note that additional charges may apply for locations where more than one clinic is requested.
How many staff work at this location?*

Please indicate the total number of staff (Headcount) working 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).
Corporate Care recommends that unless you have data from past clinics, you should estimate that 35% of staff will get vaccinated. If you estimate a participation rate greater than 35% of your staff but less than 80% of the estimated number of vaccines are administered, Corporate Care will invoice you for 80% of this estimate. If you require a longer clinic than your numbers suggest, we are happy to provide this for an additional fee. Please advise us in the ‘other details’ area on page 3 of this form.
I have requested a clinic where the number of participants is estimated to be below 20. In the event that the number of vaccines administered is less than 10 (or 15 for clinics in the Northern Territory or regional areas), I understand that Corporate Care will invoice us for 10 vaccinations (or 15 in the Northern Territory, Tasmania or regional areas).
- Yes
This will apply unless otherwise stated in the quotation.
Your participation rate (%) is estimated to be:
You have requested a clinic where the participation rate is estimated to be greater than 35%. Do you acknowledge that additional nursing time may apply if less than than 80% of the estimated number of vaccines are administered?
- Yes
Where will the clinic be held?

eg meeting room, first aid room, board room, Level 21, room 7.05
What type of appointment system would you like?*
- Online (preferred)
- 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.

GU Health Onsite Flu Clinic Booking

Clinic Details Form – GU Health

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