ONSITE MONTHLY COMPANY VITAMIN SHOT CLINIC SCHEDULING

A KMM Medical Staff will be scheduled once a month or one-time visit at designated date and time to administer. Time frame is based on number of employees A minimum requirement is 10 participants. A typical Vitamin Shot Clinic is 30-minutes and held on a day that most employees are working. Location of where the clinic is held is left up to the company, but usually held in a conference room, break room, nurse station, or empty office space.

There are two options:

Company Paid Program

KMM works with companies on payroll deduction programs or company paid programs. Company will get invoiced and receive a copy of employee waivers.

Employee Paid Program

Vitamin B-12 Shot: $15

Vitamin B-complex Shot: $30

Vitamin C Shot: $15

Vitamin D Shot: $25

Super Lipo Lean Shot: $25

Biotin Shot: $25

Glutathione Shot: $15

Amino Blend Shot: $25

Tri-Immune Shot: $50

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Vitamin Shot Clinic Request

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COMPANY NAME: *

ADDRESS OF LOCATION OF CLINIC: *

ZIP CODE: *

E-mail address: *

CONTACT PERSON: *

PHONE NUMBER: *

FAX NUMBER: *

REQUESTED DATE/DAY/TIME: *

ESTIMATED # OF EMPLOYEES PARTICIPATING: *

COMPANY PAID PROGRAM

PAYROLL DEDUCTION SET UP

Any other information you would like to communicate to KMM: *

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I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact. I am aware that I can revoke my consent at any time. I am authorizing KMM to provide our company with Vitamin Shot Clinics. I understand if in the event an employee's check is insufficient funds, I will assist KMM to assure payment is taken care of by communicating with the employee in question.

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