Gwinnett Pediatrics and Adolescent Medicine, Gwinnett Pediatricians logo for print
Gwinnett Pediatrics & Adolescent Medicine
Lawrenceville Office: 595 Hurricane Shoals Rd NE, Lawrenceville, GA 30046 | Phone: 404-355-0078
Duluth Office: 3855 Pleasant Hill Rd, Duluth, GA 30096 | Phone: 770-995-0823
Hamilton Mill Office: 2089 Teron Trace, Suite 100, Dacula, GA 30019 | Phone: 770-995-0823
Sugar Hill Office: 4700 Nelson Brogdon Blvd NE #180, Sugar Hill, GA 30518 | Phone: 770-995-0823

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You may use the form below to send a secure, online Flu shot request to our practice. Our appointment request form allows you to request a specific location and a general time and day of the week that best fits your schedule. We will do our best to accommodate your request. Once we have identified an opening, we will contact you to confirm your appointment.

Please DO NOT submit appointment request for sick-visits.

Flu Shot Request Form
Flu Shot Only  Appointment Scheduling Request Form
Parent's Name:
Child's Name:
Email Address:
Home Telephone Number:
Text Number:
Date of Birth:
Address:
City:
State:
Zip Code:
   
          Contact Method: Telephone Cell Phone Email
          Schedule Type Schedule Reschedule
   
Preferred Day:
(Saturday available at Lawrenceville office only)
Mon. Tues. Wed. Thu. Fri. Sat.
Preferred Time: Morning (AM) 9 AM - 10:45 AM
Afternoon (PM) 1:30 PM - 3:45 PM
   
Secondary Day: Mon. Tues. Wed. Thu. Fri. Sat.
Secondary Time: Morning (AM) 9 AM - 10:45 AM
Afternoon (PM) 1:30 PM - 3:45 PM
   
Appointment Type:
Office Location

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