Please READ ALL of the information below. 1) This form is only for use for the Pfizer Bivalent Omichron Boosters for patients 12 years and older. No Appointment needed and vaccines will be given on a walk-in basis Monday thru Friday from 10:00 am to 4:00 pm. DO NOT USE THIS FORM IF YOU STILL NEED A PRIMARY SERIES COVID VACCINATION. Call the pharmacy if you need a primary series vaccination. 2) You will receive a text once we have processed this form. If you come to the pharmacy before we confirm completion of this form, you will most likely have to re-complete the form in the pharmacy. 4) If you have prescription insurance coverage or Medicare (Red, White, Blue card), please upload those crads and bring those cards with you to the appointment. If you do not have prescription insurance coverage, please bring your state identification with you and have your social security number available. If you do not have either of these items, please be assured that you WILL be able to receive the vaccine. 5) Prior to arriving for your vaccine, please READ the following EUA (Emergency Use Authorization) for Recipients/Caregivers for the vaccine that you wish to receive upon arrival: Pfizer EUA for Recipients. The Pfizer Bivalent Omichron Booster can be administered, even if yoy initially receieved a Moderna Covid Vaccination.