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Vaccination Facilitation Request & Consent

After you fill out this order request, we will contact you to go over details and understand possibilities of scheduling vaccination drive for your corporate/ community and Senior Living.

If you are calling from a large corporate , bank or any other business institute with PAN India presence, then please write to us directly on malvika.arora@vaximum.in

Required *

Vaccine Request Form
Prefered Salutation
We will never spam you!
Which vaccination service you want *
Vaccination Required for *
We will never spam you!
Preferred Mode of Contact
Is there any large conference hall / community hall in your building ? *