APPOINTMENTS FULL
Due to the high demand, appointments for the J&J COVID 19 Vaccine are full. Appointments are still avilable for the Pfizer vaccine at Salida Pharmacy & Fountain.
Our sister store, Buena Vista Drug, has appointment still avaiable for both vaccine. Please visit the following links to register.
Salida Pharmacy (Pfizer) https://hipaa.jotform.com/210816908288161
Buena Vista Drug
(Pfizer) https://hipaa.jotform.com/210816552590152
J&J https://hipaa.jotform.com/210730248590149
This message will go away when we have more in stock.Please check back to this site regularly or sign up for our email notifcation list.
Salida Pharmacy COVID Vaccine Email Notification
Section I. Personal Information
Emergency Contact Information
Colorado COVID 19 Vaccine Phases (we are vaccinating all phases at this time)
Section II. Questionnaire for Immunization
The following questions will help us determine if there is any reason you should not get the COVID-19 vaccine today. If you answer “yes” to any question, it does not necessarily mean you should not be vaccinated. It just means additional questions may be asked. If a question is not clear, please ask your healthcare provider to explain it.
Section III. Signatures
I understand the benefits and risks of the COVID-19 vaccine as described in the Emergency Use Authorization (EUA) (Janssen EUA), a copy of which I was provided with this Consent and Release. I have had a chance to ask questions that were answered to my satisfaction. I request the vaccine to be given to me or to the person named above, a minor for whom I represent that I am authorized to sign this Consent and Release.
I have received a copy of the notice of Privacy Practices. I understand the notice of Privacy Practices provides an explanation of the ways in which my health information may be used or disclosed by the pharmacy and of my rights with respect to my health information. I have been provided with the opportunity to discuss concerns I may have regarding the privacy of my health information.
Section IV. Insurance/Billing Information
OR
Section V. Appointment Scheduler
Please read the following notices. Once you submit you will be redirected to the scheduling page to book your appointment.
*VACCINE SUPPLY IS LIMITED. PLEASE KEEP YOUR APPOINTMENT OR CALL IF YOU NEED TO CANCEL OR CHANGE IT. ADDITIONALLY, DUE TO VACCINE REQURIEMTNS; WE MAY CALL YOU TO SEE IF YOU CAN COME IN EARLIER, LATER, GO TO A DIFFERENT LOCATION OR RESCHEDULE TO A DIFFERENT DAY. IF YOU MISS AN APPOINTMENT, NO DOSES WILL BE HELD TO GUARANTEE YOUR DOSE.*
****IF YOU SCHEDULED TO RECIEVE THE VACCINE AT ANOTHER LOCATION. PLEASE CONTACT THAT ORGANIZATION TO CANCEL YOUR APPOINTMENT ONCE YOU RECEIVE YOUR FIRST DOSE AT OUR PHARMACY****
By clicking the "Submit" button below, you certify that the above information is correct and accurate to the best of your knowledge. All information is confidential and is accessed only via a secure, encrypted interface.