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Tuesday, Aug. 14, 2012 & Wednesday, Aug. 15, 2012
8 a.m. - 1 p.m.
Meningitis Clinic S 1080
How to Register Online For Your Immunizations
Thank you for choosing Mollen Immunization Clinics to provide you with your immunizations – we look forward to helping you protect yourself and your community.
The online registration process is simple, easy, and takes just a few minutes.
Click here to watch a demonstration:  Online Registration Video Demonstration
Your organization’s password is:  Mountain View
  1. Enter your first name, last name, and your organization’s password. Then click submit.
  2. Type in your personal information including address, date of birth, etc.
  3. Create your login account by entering your email and a password. Then click next.
  4. Select the desired services (Flu, etc.) by using the ‘Select Service’ buttons on the right side of the screen. Then click next.
  5. Answer all Medical History/Health Screening questions carefully by clicking Yes or No. Click next.
  6. Choose insurance/method of payment option. Click next.
  7. Choose your insurance provider (if applicable) and fill in your insurance information.
  8. Enter your credit/debit card information. In the event your insurance does not pay for your immunization, your credit/debit card will be charged for the balance. Your card will only be charged after the immunization has been administered and an insurance claim has been filed and denied.
  9. Review and ‘sign’ the consent form by typing your first and last name next to the signature box. Click finish.
  10. Click the link towards the bottom of the page in order to view and print the confirmation page. You must bring this form with you to the clinic in order to receive your immunization.
Once you have completed the registration process there is NO way to edit your information, so follow these instructions and enter your information carefully.
DO NOT begin the registration process unless you plan on completely filling out the form, have the most current version of Adobe Reader, and access to a printer on your computer.
Thank you for choosing Mollen Immunization Clinics to provide your immunization. If you have any problems, feel free to call us.
Be Well,
Mollen Immunization Clinics
(480) 214-2000