1
Choose your clinic
Only clinics that are currently open for sign-ups appear in the dropdown. Pick the workplace and date your employer scheduled with us.
Broulim's Pharmacy - your trusted neighborhood vaccine clinic team
Licensed Pharmacists - on-site workplace clinics
Your vaccine consent form, done before clinic day
Pick the clinic your employer scheduled, tell us which vaccines you want, and attach your signed consent form and insurance card. It takes about five minutes on your phone.
- Flu, COVID-19, or request another vaccine
- Every question and consent form in English or Spanish
- Sent straight to the Broulim's Pharmacy clinic team
Not sure which clinic to pick? Choose your workplace from the list.
Three steps
What you'll need before you start
2
Answer a few questions
Give us your name and date of birth, tell us whether you are 65 or older, and select the flu vaccine, the COVID-19 vaccine, or request a different one.
3
Attach and send
Download the consent form in your language, sign it, then attach it along with a photo of your insurance card. Everything arrives with our clinic team instantly.
Clinic offerings
Choose what you want at your clinic
Your selections tell us exactly how much vaccine to bring to your workplace, so nothing runs short on clinic day.
Influenza (Flu)
Seasonal flu vaccine for adults. If you are 65 or older we plan for the high-dose senior formulation, so please answer the age question in the form.
Standard and 65+ high-dose available
Select in form
COVID-19
The current season's COVID-19 vaccine. You may receive it at the same visit as your flu shot if you choose both in the form.
Can be given the same day as flu
Select in form
Request another vaccine
Need Tdap, shingles, pneumococcal, hepatitis, or something else? Tell us in the form and our pharmacist will confirm availability before clinic day.
Pharmacist confirms availability
Select in formConsent form
Fill it out here, in English or Spanish
Use the language switch at the top of the page at any time. Every question and the downloadable consent form change with it, so you always sign the version you can read.
- Switch between English and Spanish without losing your answers.
- About five minutes, and it works well on a phone.
- Your form and insurance photo go only to the Broulim's Pharmacy clinic team.
Consent forms to download
Preview or download the exact consent form for your language, or fill in your answers above and we'll send your submission straight to our clinic team.
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Care from your neighborhood pharmacy team
Broulim's Pharmacy has immunized eastern Idaho families and workplaces for years. Here is what comes with every on-site clinic.
Licensed pharmacists
We come to your workplace
English and Spanish support
Most insurance billed directly
Immunization records filed
Vaccine supply planned ahead
Questions people ask before clinic day
Anyone attending a Broulim's Pharmacy on-site clinic that your employer or organization scheduled with us. Submit one form per person receiving a vaccine.
Contact
Talk to the Broulim's Pharmacy clinic team
Emailfallyn@broulims.com