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Flu Clinic

How To Register Online For Your Immunizations


Flyer: 1604 Main Campus | Downtown Campus

The online registration process is simple, easy, and takes just a few minutes.

Your organization’s link is:
Your organization’s password is: Texas

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

5. Answer all of the 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 at the center of the page that reads “Flu consent form” in order to view, and print the Consent Form.

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.

Be Well,

Mollen Immunization Clinics
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October 24, 2012