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Allergy Shot Clinic Hours:

West Des Moines
Monday: 1-5pm
Wednesday: 8:30-10:30am & 1-4pm
Thursday: 7:30am-1:30pm

Ankeny
Tuesday: 8-11am

Reorder Allergy Serum

All fields marked with * are required.

ALLERGY SERUM REORDER FORM

First Name *

Last Name *

Date of Birth *

Phone *

Email *

Date Ordered *

Date Needed *

Please allow up to 2 weeks for processing and completion of order.

Date EPI-PENS Expire *

How Often Do You Administer Your Allergy Shots? *

Address where you would like your serum sent *

City *

State *

Zip *

I will pick up my serum at the West Des Moines office. Call when ready.

Insurance *

Annual physician visits are REQUIRED to continue allergy treatment

Last Seen On *

File upload must be less than 2 MB and an image file type of .gif, .jpg, .jpeg, .tiff, .png

Administration Log *

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