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COVID-19 Vaccine Appointment Cancellation Form
Hi there, please fill out and submit this form.
8
Questions
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1
Name
First Name
Last Name
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2
Please enter your Date of Birth
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3
Phone Number
Area Code
Phone Number
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4
Email
example@example.com
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5
Which type of appt were you scheduled for?
Covid Dose 1 or 2
Other (Flu, Shingles, Tetanus, etc...)
COVID BOOSTER
COVID TESTING APPT
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6
Please Enter the date of your appointment you are cancelling
-
Date
Year
Month
Day
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7
Please add any comments that could help our team.
EX: I signed up twice, please cancel this appt, or I live off-island and didn't realize I had to take a ferry to get to the site....
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8
By signing below I understand that I am cancelling my appointment. I understand that this process cannot be undone. If this is a dose 1 appointment that is being cancelled I understand that both my dose 1 and dose 2 appointments will be cancelled.
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