COVID-19 Vaccine Waitlist!
Once you fill out this form, we will add you to Fisherville Pharmacy's waitlist. The purpose of this waitlist is to ensure that no vaccine doses are wasted. If you are eligible and wish to receive the COVID-19 vaccine please fill out this form and we will contact you if a last minute dose becomes available. Please note that we still encourage individuals to register with the State of NH or with us to create a vaccine appointment. The purpose of the waitlist is simply to provide the vaccine sooner than your scheduled appointment if Fisherville Pharmacy has patients who do not show. We appreciate your patience and understanding. Please email MacKenzie@fishervillerx.com if you receive your COVID-19 vaccine and need to be removed from the waitlist.
First or Second Dose?
This will help us determine eligibility.
Date of First Dose? First dose must have been Moderna.
Are you registered on the state of New Hampshire's VINI site?
Please enter a valid phone number.
Street Address Line 2
State / Province
Postal / Zip Code
219 Fisherville Rd Unit C Penacook NH 03303
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