Contact us now: ☎ (561) 247-1577 ✉ Jeff@vaccinevanrx.com ¡Hablamos Español!

About Vaccines Vaccine Guide RPM Program For Physicians Meet the Pharmacist Contact Schedule

Mobile Pharmacy • Licensed in Florida

Schedule your visit

Book with Vaccine Van Rx

We come to you — no waiting rooms, no travel. Choose your appointment type below. Now accepting vaccine appointments throughout South Florida in Martin, Palm Beach, Broward, and Dade counties. If you would like to schedule a Vaccine Clinic outside of this area, please email us to discuss!

Individual

Book My Appointment

One person, one visit. We come to your home, office, or location of your choice.

Get started →

Group / Facility

Request a Clinic

On-site vaccine clinic for your workplace, nursing home, ALF, or group event.

Get started →

Book My Appointment

We’ll contact you within one business day to confirm. * required.

About you

First name *

Last name *

Date of birth *

Phone *

Email *

Your location

ℹ️ We come to you. Enter the address where you’d like your vaccination administered.

Please note: The site owner is responsible for providing the pharmacist a clean, safe environment to administer vaccines, including a table and chair. The pharmacist supplies all other materials and removes and disposes of any and all waste at an appropriate off-site location (never at the appointment site).

Street address *

City *

ZIP *

⚠️ We serve Palm Beach, Broward, Miami-Dade & Martin counties. Submit anyway and we’ll reach out.

Preferred appointment

Preferred date *

Mon–Fri, 8 AM–6 PM. 48-hour minimum notice.

Preferred time

Vaccines — check all that apply

B-12 (cyanocobalamin) Injection Chickenpox / Varicella (Varivax) (live)* COVID-19 (2025–26 season) Flu (Influenza) (coming soon — August 2026 for the 2026–27 season) Hepatitis A (Havrix) Hepatitis A & B Combination (Twinrix) Hepatitis B (Heplisav-B) HPV — Human Papillomavirus (Gardasil 9) Measles, Mumps & Rubella (MMR) (live)* Meningitis ACWY (MenQuadfi) Meningitis B (Bexsero) Haemophilus influenzae b (Hiberix) Pneumococcal / Pneumonia — Prevnar 20 (PCV20) Pneumococcal / Pneumonia — Capvaxive (PCV21) Splenectomy Series (bundle) Healthcare Worker Series (bundle) Travel Worker Series (bundle) RSV — Arexvy RSV — Abrysvo Shingles (Shingrix) Tetanus, Diphtheria & Whooping Cough (Boostrix / Tdap)

* Only one live vaccine (Varicella or MMR) may be administered on a single day.

Not sure? Leave blank and tell us in notes.

Insurance / payment

How will you pay? *

ℹ️ Use your prescription/pharmacy card — not your medical card. We’ll verify coverage before your visit.

Insurance plan name

RxBIN *

On your prescription card.

RxPCN

RxID / Member ID *

RxGroup

Notes

Pre-vaccination screening & consent

ℹ️ Please answer honestly. A “Yes” does not necessarily prevent vaccination — the pharmacist reviews any Yes before administering. If under 18, Florida pharmacists may only administer the influenza vaccine (age 7+).

1. Are you 18 years of age or older? Yes No

2. Are you sick today, or do you have a fever (100.4°F or higher) or a moderate-to-severe acute illness? Yes No

3a. Do you have any allergies to medications, foods, or environmental triggers? Yes No

Describe

3b. Do you have a known allergy to a vaccine component (latex, neomycin, gelatin, egg, polysorbate-80, PEG, or yeast)? Yes No

Describe

4. Have you ever had a serious or life-threatening reaction (such as anaphylaxis) to a vaccine or vaccine component? Yes No

5. Have you ever fainted, felt dizzy, or had a seizure after a vaccination? Yes No

Describe

6a. Do you have any of the following: a long-term health problem with heart, lung, kidney, or liver disease, a metabolic disease (such as diabetes), asthma, a neurologic condition, cancer, a blood disorder, no spleen or a spleen that does not work, a cochlear implant, or a spinal fluid leak? Are you on long-term aspirin therapy? Yes No

Describe

6b. Do you have a bleeding disorder or low platelets, or take an anticoagulant (warfarin, apixaban, rivaroxaban, dabigatran, or heparin)? Yes No

Describe

7. Have you ever been diagnosed with Guillain-Barré Syndrome or another demyelinating disorder? Yes No

8. Are you currently pregnant, planning to become pregnant within the next month, or breastfeeding? Yes No

9. Have you received a COVID-19 vaccine in the past 6 months? Yes No

10. Have you ever been diagnosed with a heart condition (myocarditis or pericarditis), or have you had Multisystem Inflammatory Syndrome (MIS-A or MIS-C) after an infection with the virus that causes COVID-19? Yes No

11. Have you received any other vaccinations in the past 4 weeks? Yes No

Describe

12. Do you have a weakened immune system (HIV, cancer, transplant, high-dose steroids, chemotherapy, or radiation)? Yes No

Describe

13. In the past 6 months, have you taken medicines that affect your immune system, such as prednisone, other steroids, or anticancer drugs; drugs for the treatment of rheumatoid arthritis, Crohn’s disease, or psoriasis; or have you had radiation treatments? Yes No

Describe

14. Do you have a parent, brother, or sister with an immune system problem? Yes No

15. Do you live with, or have close contact with, anyone who has a severely weakened immune system? Yes No

16. In the past year, have you received a blood or blood-product transfusion, immune (gamma) globulin, or an antiviral medication? Yes No

Describe

Consent to Vaccinate. I voluntarily request and consent that a Vaccine Van Rx, LLC pharmacist or other qualified VVRx provider administer the vaccine(s) I selected to me (or to the patient for whom I am legally authorized to consent). I have been made aware of the material benefits and risks (local reaction, systemic reaction, syncope, and rarely anaphylaxis) and reasonable alternatives (including declining). I confirm I received or was offered the current CDC VIS / EUA Fact Sheet for each vaccine, had a meaningful opportunity to read it and ask questions, and understand the benefits and possible adverse reactions. This consent is given pursuant to and is intended to satisfy §766.103, Fla. Stat.

Truthfulness of Screening. I certify the information above is true and complete to the best of my knowledge, and that inaccurate or omitted information may increase the risk of an adverse reaction and may affect the validity of this consent.

Insurance Assignment of Benefits. If I provided insurance information, I authorize VVRx to submit claims to my insurer and assign the right to receive payment directly. I understand I may be responsible for deductibles, copays, coinsurance, or non-covered services, and that an ABN (CMS-R-131) is provided where a Medicare denial is expected.

Privacy & Reporting. I acknowledge VVRx provided or offered its Notice of Privacy Practices (below), describing how my PHI is used for treatment, payment, operations, and as required by law, including Florida SHOTS and VAERS reporting.

I have read and agree to the consent above, and I certify my screening answers are true and complete. *

Signature — type your full legal name *

I received or was offered the Notice of Privacy Practices.

View the Notice of Privacy Practices

Notice of Privacy Practices (HIPAA). VVRx may use and disclose your protected health information without separate written authorization for treatment, payment, and health-care operations, and as required or permitted by law (45 C.F.R. §§164.502, 164.506, 164.512) — including Florida SHOTS reporting, VAERS reporting, and public-health activities. Other uses require your written authorization, which you may revoke in writing to the Privacy Officer (revocation is not retroactive and does not affect legally required disclosures). You may request restrictions, request confidential communications, inspect and copy your records, request amendments, and obtain a paper copy of the current Notice of Privacy Practices, which governs and is posted at the point of service and at vaccinevanrx.com (45 C.F.R. §164.520). Full notices — including Vaccine Injury Compensation (VICP), VAERS, billing / No Surprises, records retention, and data security — are posted at vaccinevanrx.com and at the point of service.

I opt out of Florida SHOTS reporting (VAERS reporting is required and cannot be opted out). I consent to vaccination reminders / second-dose follow-up by phone, text, or email.

We’ll contact you to confirm. * required.

Request a Clinic

On-site vaccine clinics for workplaces, nursing homes, ALFs, and group events. After submitting, you’ll receive a QR code to share with participants. * required.

Organization

Facility / business name *

Type of organization *

Contact person

Your name *

Your role / title

Phone *

Email *

Clinic location

Site address *

City *

ZIP *

⚠️ We serve Palm Beach, Broward, Miami-Dade & Martin counties. Submit anyway and we’ll reach out.

Clinic details

Estimated # of participants *

Used to estimate how long to block for your clinic.

Preferred date *

Vaccines of interest — check all that apply *

Chickenpox / Varicella (Varivax) (live)* COVID-19 (2025–26 season) Flu (Influenza) (coming soon — August 2026 for the 2026–27 season) Hepatitis A (Havrix) Hepatitis A & B Combination (Twinrix) Hepatitis B (Heplisav-B) HPV — Human Papillomavirus (Gardasil 9) Measles, Mumps & Rubella (MMR) (live)* Meningitis ACWY (MenQuadfi) Meningitis B (Bexsero) Haemophilus influenzae b (Hiberix) Pneumococcal / Pneumonia — Prevnar 20 (PCV20) Pneumococcal / Pneumonia — Capvaxive (PCV21) Splenectomy Series (bundle) Healthcare Worker Series (bundle) Travel Worker Series (bundle) RSV — Arexvy RSV — Abrysvo Shingles (Shingrix) Tetanus, Diphtheria & Whooping Cough (Boostrix / Tdap) Not sure — please advise

* Only one live vaccine (Varicella or MMR) may be administered on a single day.

Select all. Participants will confirm their individual choices when they scan the QR code.

Coverage type (if known)

Additional notes

A QR code appears immediately after submission. * required.

Vaccine Van Rx — Participant Registration

Complete this form to register for your vaccination. * required.

About you

First name *

Last name *

Date of birth *

Phone *

Email *

Vaccines you want today — check all that apply

* Only one live vaccine (Varicella or MMR) may be administered on a single day.

Pre-selected based on your clinic’s offerings. Adjust as needed.

Insurance / payment

How will you pay? *

ℹ️ Use your prescription/pharmacy card — not your medical card. We’ll verify coverage before your visit.

Insurance plan name

RxBIN *

On your prescription card.

RxPCN

RxID / Member ID *

RxGroup

Pre-vaccination screening & consent

1. Are you 18 years of age or older? Yes No

2. Are you sick today, or do you have a fever (100.4°F or higher) or a moderate-to-severe acute illness? Yes No

3a. Do you have any allergies to medications, foods, or environmental triggers? Yes No

Describe

3b. Do you have a known allergy to a vaccine component (latex, neomycin, gelatin, egg, polysorbate-80, PEG, or yeast)? Yes No

Describe

4. Have you ever had a serious or life-threatening reaction (such as anaphylaxis) to a vaccine or vaccine component? Yes No

5. Have you ever fainted, felt dizzy, or had a seizure after a vaccination? Yes No

Describe

6b. Do you have a bleeding disorder or low platelets, or take an anticoagulant (warfarin, apixaban, rivaroxaban, dabigatran, or heparin)? Yes No

Describe

7. Have you ever been diagnosed with Guillain-Barré Syndrome or another demyelinating disorder? Yes No

8. Are you currently pregnant, planning to become pregnant within the next month, or breastfeeding? Yes No

9. Have you received a COVID-19 vaccine in the past 6 months? Yes No

11. Have you received any other vaccinations in the past 4 weeks? Yes No

Describe

12. Do you have a weakened immune system (HIV, cancer, transplant, high-dose steroids, chemotherapy, or radiation)? Yes No

Describe

14. Do you have a parent, brother, or sister with an immune system problem? Yes No

15. Do you live with, or have close contact with, anyone who has a severely weakened immune system? Yes No

16. In the past year, have you received a blood or blood-product transfusion, immune (gamma) globulin, or an antiviral medication? Yes No

Describe

I have read and agree to the consent above, and I certify my screening answers are true and complete. *

Signature — type your full legal name *

I received or was offered the Notice of Privacy Practices.

View the Notice of Privacy Practices

I opt out of Florida SHOTS reporting (VAERS reporting is required and cannot be opted out). I consent to vaccination reminders / second-dose follow-up by phone, text, or email.

Notes

Your information is protected under HIPAA. * required.

✓

Request received

We’ll contact you within one business day to confirm your appointment.

Questions? Call (561) 247-1577.

✓

Clinic request received!

We’ll confirm your clinic within one business day. Share the QR code below with everyone who wants to be vaccinated at your clinic.

💉 Participant Registration QR Code

Each participant scans this code on their phone to register, provide consent, and enter insurance information before clinic day — so everything is ready when we arrive.

Questions? Call (561) 247-1577 or email jeff@vaccinevanrx.com.

✓

You’re registered!

Your registration and signed consent have been received. Vaccine Van Rx will have your information ready on clinic day.

What to bring: your insurance card (prescription side) and a photo ID.

Questions? Call (561) 247-1577.

Transparent Pricing

Vaccine cash prices

Per-dose, all-in — the price includes the vaccine and administration at your location.

Most people pay $0. Commercial insurance, Medicare, and Medicaid cover these vaccines at no cost to you — we'll check your coverage before your visit. Cash pricing below is for uninsured or out-of-network visits.

Influenza (Flu)

Flu — seasonal2026–27 season · available August 2026Coming Aug 2026

COVID-19

COVID-192025–26 season · Novavax / Spikevax / ComirnatyConfirmed at booking

Seasonal — currently the 2025–26 formula. The updated COVID-19 vaccine typically arrives Aug–Oct.

Pneumococcal

Prevnar 20$395

Capvaxive$395

Hepatitis

HavrixHep A$160

TwinrixHep A + B · per dose$215

Heplisav-BHep B · per dose$220

Shingles

Shingrixper dose · 2-dose series$300

RSV

ArexvyRSV · GSK$385

AbrysvoRSV · Pfizer$385

HPV

Gardasil-9per dose$360

Tetanus / Tdap

BoostrixTdap$110

Measles (MMR)

MMRmeasles · mumps · rubella$150

Varicella

Varivaxchickenpox · per dose$250

Meningococcal

MenQuadfiMenACWY$265

BexseroMenB · per dose$310

Haemophilus (Hib)

Hiberix$95

Other

B-12 injectioncyanocobalamin$25

Prices are per dose and include administration. Series vaccines (Shingrix, Twinrix, Heplisav-B, Gardasil-9, Bexsero) are billed per dose. Prices current as of July 2026 and subject to change; 2026–27 flu pricing is confirmed at season open. Availability of some products may vary.

Vaccine Van Rx, LLC

Permit PH36499 · 925 S Military Trail, Ste D7, West Palm Beach FL 33415
(561) 247-1577 · jeff@vaccinevanrx.com · vaccinevanrx.com
Licensed Florida Pharmacist · Serving Palm Beach, Broward, Miami-Dade & Martin Counties