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Carlsbad School Employee

Immunization Request Form

 

 

Carlsbad residents may attend weekly clinics:

Advanced Medication

2402 W. Pierce St. Ste. 2B

Wednesdays 2:00pm-5:00pm

Please bring your insurance card.

 

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.

 

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You may print a paper request form to be turned in at the

time of immunization to decrease your waiting time.

 

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:

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