Please complete this form for each patient that will be receiving a vaccine prior to scheduling an appointment.
Masks are required for everyone over the age of 2 who enters our store.
Please do not forget your vaccination record card if you are coming in for a second or third dose of a COVID-19 vaccine. If this is your first dose, we will schedule your second dose during your appointment.
Do you have the Pfizer vaccine for kids 5-11?
Yes! It is available for booking at the end of this form. Please complete this form to be directed to scheduling.
Do you have the ____ vaccine in stock? What about the booster?
Yes. We have all of the COVID-19 vaccines in stock- J&J, Moderna, and Pfizer. The boosters are all the same so they are also in stock.
** Although we have all of the vaccines in stock, we may not have appointments available for your desired vaccine.
Can I get a booster?
Yes, if you initially received the second dose of a Pfizer or Moderna vaccine at least six months ago OR a Johnson & Johnson vaccine at least two months ago, you are eligible. If you are severely immunocompromised, you may get another dose of mRNA vaccine at least four weeks after your second dose.
Can I just walk in for a COVID vaccine?
No, COVID vaccines require appointments. We cannot accomodate walk ins.
My friend walked in for a COVID vaccine last week.
We have seen a sharp increase in demand and are now unable to accomodate walk ins.
Can I get on a list for cancelations or extra doses?
We do not keep such a list, we schedule our appointments so we do not have extra doses and if an appointment cancels, the appointment will now show up on the scheduling page.
Do I need an appointment for a flu/shingles/other vaccine?
You may book an appointment for other vaccinations on our website or walk in.
I don’t see any appointments on your website. What’s wrong?
Nothing is wrong, if you do not see appointments, then all appointments are booked as the COVID vaccine is in high demand. We will release more appointments periodically.
Do you really need all this information?
I can't enter my Medicare Part B number.
Make sure you are inputting the new Part B identification number. It should be a combination of letters and numbers, not your SSN with a letter after it. The form will not allow you to enter your old identification number. If you do not have it, call 1-800-MEDICARE.
I have a Medicare Advantage Plan.
Please enter your Part B number, COVID vaccines go through Part B regardless of other coverage.
Should I show up early for my appointment?
No, please come at your scheduled appointment time.
If you have any questions regarding COVID-19 vaccinations please contact us at firstname.lastname@example.org as we are unable to accomodate phone calls on this matter while continuing to SAFELY serve patients in our store.