Covid-19 Immunization Appointments

Name:*

First NameLast Name

Date of Birth:*

MonthDayYear

Phone Number:*

Please enter a valid phone number.

Email:

(Optional) We will use this to send an appointment confirmation email as well as an appointment reminder email.

Currently, 3 different COVID-19 vaccines are authorized and recommended in the United States. Please review the following information and choose 1 vaccine product that you would like to recieve.

COVID-19 vaccines are authorized for different age groups and are given intramuscularly as a two-dose series or single dose.

** An additional third dose of Moderna or Pfizer may be indicated for certain patients that are moderately to severely immunocompromised.

VACCINE PRODUCT	AUTHORIZED AGE GROUPS	SERIES	INTERVAL
Pfizer-BioNTech COVID-19 Vaccine	12 years of age and older	2 doses	21 days
Moderna COVID-19 Vaccine	18 years of age and older	2 doses	28 days
Janssen COVID-19 Vaccine (Johnson & Johnson)	18 years of age and older	1 dose	N/A

Use the links below to find out more information about each vaccine being offered.

More Information About Each Vaccine

Moderna - Recipient Fact Sheet and EUA

Janssen (J&J) - Recipient Fact Sheet and EUA

Pfizer - Recipient Fact Sheet and EUA

Additional Booster Shots

Which COVID-19 vaccine would you like to receive?*

Pfizer (1st or 2nd dose)(Ages 12+)Moderna Bivalent Booster (New)Pfizer Bivalent Booster (New)

Please confirm that you are within the authorized age group for the vaccine you selected.

Yes, I am 18 years old or older (or 12 years and older for Pfizer)No, My age is not within the authorized age range.

Please review the self-attestation form and confirm that you have one of the high-risk medical conditions listed. You will be required to sign this form before receiving the 3rd booster shot.

PICK AN AVAILABLE DATE AND TIME FOR YOUR APPOINTMENT AT CHRIS' PHARMACY IN MAUREPAS.

(CURRENTLY, WE ARE OFFERING VACCINES EVERY THURSDAY AND FRIDAY ONLY)

**DO NOT SCHEDULE MORE THAN ONE APPOINTMENT. IF YOU NEED TO CHANGE YOUR APPOINTMENT TIME, CALL CHRIS' PHARMACY IN MAUREPAS AND WE CAN CHANGE IT FOR YOU. ** (225) 267-4340 **

**IF YOU ARE SCHEDULING A BOOSTER SHOT YOU NEED TO BRING YOUR VACCINATION CARD TO YOUR APPOINTMENT TO BE UPDATED.**

PLEASE NOTE: Due to the high demand for COVID-19 immunizations and the recent Delta Variant outbreak, appointment times may be changed or slightly delayed over the next couple of weeks.

Choose a Chris' Pharmacy location:*

Chris' Pharmacy & Gifts (Maurepas)

Pick an available date and time at Chris' Pharmacy in MAUREPAS:*

Please share anything that will help prepare for our meeting:

Sorry, you are not eligible for the chosen vaccine at this time.

The Moderna and Janssen (J&J) vaccine can only be given to patients that are ages 18 and older.

If you would like to recieve news and updates about the COVID vaccine, please subscribe to our COVID Immunization newsletter using the link below.

COVID Immunization Newsletter - Sign Up Here!

Sorry, you are not eligible for the chosen vaccine at this time.

The Pfizer COVID-19 vaccine can only be given to patients that are ages 12 and older.

If you would like to recieve news and updates about the COVID vaccine, please subscribe to our COVID Immunization newsletter using the link below.

COVID Immunization Newsletter - Sign Up Here!