1st Dose COVID-19 Vaccine
Welcome! Visit this link https://www.phila.gov/programs/coronavirus-disease-2019-covid-19/guidance/faq/#vaccines for more information.
Completing this form will allow you to schedule an appointment to receive the COVID-19 vaccine at
Fairmount Pharmacy
1900 Green Street
Philadelphia, PA, 19130
PLEASE BRING YOUR INSURANCE CARD AND ID.
PLEASE WEAR SHORT SLEEVES FOR EASE OF ACCESS TO INJECTION SITE.
AFTER SUCCESSFULLY SUBMITTING YOUR FORM YOU WILL RECEIVE A CONFIRMATION MESSAGE ON THE SCREEN. THIS IS THE ONLY CONFIRMATION YOU WILL RECEIVE.
YOU WILL NOT RECEIVE AN EMAIL CONFIRMATION
We look forward to seeing you!