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Albuquerque
DOT
Immunization
Request Form
Next
Clinic Date TBA
District
3 Auditorium
Online
sign-ups are now closed.
You
may print a paper request to be
turned
in a the above clinic:
Paper
Request Form
*In
order to open this Immunization Request Form you must have
Adobe
Acrobat
Reader. To download this free program please click the
link below:
_____________________________________________________
You MUST present the following
card in order to receive your vaccinations with no copay
for you and/or insured dependents:
A
Medco Rx prescription card
(pictured
left) provided by the New Mexico Public Schools Insurance
Authority or the State of New Mexico.
As
this is a benefit of the prescription insurance coverage,
those not covered under one of the above insurance program
will be responsible for the cost of immunizations. You
may follow the link below to view Cash pricing for all
available vaccinations.
NO/OTHER
Prescription Coverage? CLICK HERE to see pricing
details. If
you would prefer not to submit a request online, you may print
a paper request form to be turned in a the time of
immunization:
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