Dripping Springs Pharmacy Vaccine Appointments

Dripping Springs Pharmacy Vaccine Appointments

100 Commons Road Suite 1 Dripping Springs, Texas 78620
Thank you for choosing Martin's Wellness and Compounding Pharmacies for your vaccines! You can book an appointment for any vaccine at our pharmacies, subject to availability. Appointment times will be for a maximum of 2 vaccines at a time. If you need 3 or more vaccines, please book an additional appointment time through this same link.

Children 3 and older do not need a prescription for the vaccine. Children UNDER THE AGE OF 3 need to ask their physician to send a prescription to our pharmacy prior to their appointment.

To cancel an appointment, please email store@cpdwellness.com with which location, appointment date and time, and name.

COVID-19 Vaccine Updates

An additional bivalent COVID-19 vaccine for adults 65 years and older and those that are moderately or severely immunocompromised is now available!
- People 6 years and older who have already received a bivalent Moderna or Pfizer COVID-19 vaccine do not need any additional COVID-19 vaccines at this time, unless they are 65 years and older or are immunocompromised
  - Adults 65 years and older who have received a single dose of a bivalent vaccine may receive one additional dose at least four months following their initial bivalent dose
  - Individuals ages 6 years and older who are moderately or severely immunocompromised and have received a bivalent COVID-19 vaccine may receive an additional dose of a bivalent COVID-19 vaccine at least 2 months following a dose of a bivalent COVID-19 vaccine, and additional doses may be administered at the discretion of their health care provider
- Monovalent (original) Moderna and Pfizer COVID-19 vaccines are no longer recommended for use in the United States
- Everyone ages 6 years and older who are unvaccinated or previously received only monovalent vaccine doses should receive a bivalent COVID-19 vaccine, regardless of if they previously completed their (monovalent) primary series
- At the time of initial vaccination, depending on vaccine product, children ages 6 months–4 years are recommended to receive 2 or 3 bivalent COVID-19 vaccine doses; children age 5 years are recommended to receive 1 or 2 bivalent COVID-19 vaccine doses
- Updated formulations for the bivalent COVID-19 vaccines are not expected to be released until Fall 2023
If you received a COVID-19 vaccine after the date the bivalent vaccine was rolled out for your age group, you received the bivalent vaccine. The dates that FDA and CDC approved the updated bivalent COVID-19 vaccine for each age group are:
- People 12 years and older: September 2, 2022
- Children 5-11 years old: October 12, 2022
- Children 6 months-5 years old who received Moderna or children 6 months-4 years old who received Pfizer: December 9, 2022

Appointment
Vaccine Appointment*
Primary Series Appointment

Patient Demographics
Appointment Date

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Date of Birth*

MonthDayYear
Gender*

MaleFemaleOther
Email*
example@example.com
By initialing below, I acknowledge that my primary care provider must send our pharmacy a prescription for my child's vaccine being requested PRIOR TO THEIR VACCINE APPOINTMENT. Children less than 3 years old require a prescription for vaccines to be administered at our pharmacy and we are unable to administer the vaccine without a prescription from your primary care provider.*

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Insurance
Do you have insurance?*

I have Medicare Part B (Red, White, and Blue Medicare A/B card with letters and numbers)I have commercial PRESCRIPTION insuranceI have Medicaid insuranceI have no insurance
What is your Medicare Number?
Letters and numbers on your Red, White, and Blue Medicare Part A/B card
What is your Medicaid ID?
Prescription Insurance Card
Please attach a picture of your prescription insurance card.

Browse Files

Cancelof
Please attach a picture of your medical insurance card.

Browse Files

Cancelof
Zip code for insured
Please bring a copy of your insurance card(s) with you to your appointment.
To decrease wait times in the pharmacy, would you like to fill out your consent form today?*
If you answer NO, please arrive at the pharmacy at least 10 minutes prior to your appointment to complete your paperwork

Vaccine Administration Information

	Vaccine	Lot	Expiration	Mfg/Dose	Inj Site	Dose/VIS
COVID-19
Flu
Other
Other

Immunizer Signature
Date Vaccine(s) Administered

MonthDayYear
Date
Dripping Springs Pharmacy Consent Form

Authorization and Consent
Unfortunately, you are not eligible for this dose of the COVID-19 vaccine at this time. Please check back to our website later.
Unfortunately, you are not eligible for this vaccine at this time due to age limits. Please check back to our website later.
Unfortunately, we have limited inventory of Pfizer Monovalent 5-11 Years Old at this time and do not have any more available appointments. Please check back to our website on 10/14/2022 for more updates.
Age
I acknowledge that I understand the benefits and risks of the requested vaccination as described in the Vaccine Information Sheet or Emergency Use Authorization Fact Sheet, a copy of which is provided with this Consent and Release. I confirm that Dripping Springs Pharmacy has answered to my satisfaction all of my questions about the vaccine and the vaccination procedure. I request and consent that the vaccination be given, as I direct Dripping Springs Pharmacy, either to me or to the person named above, a minor for whom I represent that I am authorized to sign this Consent and Release. I understand that I am giving Dripping Springs Pharmacy permission to release any medical or other information necessary to my physician, Medicare, Medicare HMO, or insurance company or immunization registry, as applicable, to enable Dripping Springs Pharmacy to process my insurance claims with respect to the vaccination.

I, for myself (and for the recipient of the vaccination, if the recipient is a minor), my heirs, executors, and assigns hereby release Dripping Springs Pharmacy and its affiliates, owners, employees, agents, and representatives from any and all claims arising out of or in connection with the quality of the above-described vaccine(s) as provided by the manufacturer and any negligence of Dripping Springs Pharmacy in connection with the related injection of the vaccination. I understand that the laws of my state may affect my remedies in connection with this vaccination.
Signature of Person to Receive Vaccine(s) (or parent or guardian if recipient is < 18 years old)*

Clear
Should be Empty:

	YES	NO	DON'T KNOW	Notes
1. Are you sick today or have you had any COVID-19 symptoms in the past 10 days?
2. In the past 10 days, are you aware of being exposed to someone who tested positive for COVID-19?
3. Have you had a positive test for COVID-19 or has a doctor ever told you that you had COVID-19?
4. Have you had a serious allergy to ANY medication, vaccine, or foods? This includes vaccines, food, pet, venom, environmental, or medication allergies. If YES, please list.
5. Are you moderately or severely immunocompromised? This includes receiving active cancer treatment for tumors or blood cancers, organ transplant recipient or stem cell transplant recipient within the last 2 years and on immunosuppressants, moderate or severe primary immunodeficiency (i.e. DiGeorge or Wiskott-Aldrich syndrome), advanced/untreated HIV infection, and/or treatment with high-dose corticosteroids or drugs that suppress your immune response.
6. Do you have a history of or a risk factor for a blood clotting disorder?
7. Have you ever had Guillain-Barré Syndrome (a type of temporary severe muscle weakness), a brain disorder, or a seizure disorder?
8. For Women: Are you pregnant or are you considering becoming pregnant?

Dripping Springs Pharmacy Vaccine Appointments

Vaccine Selection

Appointment

Patient Demographics

Insurance

Screening Form

Authorization and Consent