Instructions: Providers are required to request approval by the Vaccines for Children (VFC) Program to host off-site clinics.
*Do NOT conduct an off-site clinic before getting approval from the VFC Program.
The VFC Program will process the requests for off-site clinic request forms received between 8:30 am and 4:30 pm the same day. Forms received after 4:30 pm will be processed the next business day.
Hit the SUBMIT button at the end of this form. After submitting the form, an email confirmation will be sent. Keep a copy of the VFC Off-Site Clinic Request form for your records.