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State of New Mexico Albuquerque

Immunization Request Form

 

 

CLINIC DATES/TIMES/LOCATIONS COMING SOON!

 

Bernalillo County Metropolitan Court

401 Lomas NW

Albuquerque, NM 87102

 

Office of the District Attorney

520 Lomas Blvd. NW

Albuquerque, NM 87102

 

Bernalillo County Courthouse

400 Lomas NW

Albuquerque, NM 87102

 

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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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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.