You are not eligible for the RSV vaccine.
Your vaccine choices are incompatible with each other. Please change your vaccine choices to be different from each other. You cannot pair two different flu shots, two different COVID-19 vaccines, or other choices intended to protect against the same virus.
You do not meet the age requirement for one or more of your vaccine choices. Due to this, you will not be able to submit this form unless you change your vaccine choice(s).
The following questions about allergic reactions would include a severe allergic reaction [e.g., anaphylaxis] that required treatment with epinephrine or EpiPen® or that caused you to go to the hospital. It would also include an allergic reaction that caused hives, swelling, or respiratory distress, including wheezing.)
I authorize Park Chemists to report the administration of this immunization to the Citywide Immunization registry (CIR) and my Primary Health Care Provider.