Flu Shot Clinic | Dec 27 Signup
ā„ļø IN COLLABORATION WITH CVS PHARMACY
ā° ON SUNDAY, DEC 27, 2020 | 11AM TO 3:30PM
š ADDRESS: Sikh Gurdwara of Tampa Bay (USREF),
15302 Morris Bridge Road, Tampa, FL 33592
Saadh Sangat ji, Tampa Gurdwara is organizing a Free Flu Shot Clinic in collaboration with CVS pharmacy on Sunday, Dec 27, 2020. The free clinic will be conducted from 11.00AM to 3.30PM.
ā ļø1ļøā£ For the needy & the sangat members without insurance, the cost will be fully covered by Tampa Gurdwara sahib on strictly first come first serve basis. š All information is kept strictly confidential.
ā ļø2ļøā£ Insured members must register at above form on or before Thursday, Dec 24th, 2020. Registration is purely on first come first serve basis. You can choose your preferred timings in the form itself. All information is kept strictly confidential.
All these initiatives are propelled by the generous donations by Tampa Bay Sangat. You can support our future initiatives by donating at the following link:
ā
https://tampagurdwara.com/donations
Waheguru ji ka Khalsa,
Waheguru ji ka Khalsa! š
ā ļø Disclaimer: Tampa Gurdwara (USREF) reserves the right to share the digital content on it's public platforms. Please feel free to contact us if there is any content that you would not like to be shared. However, please note this request can be only selectively enforced.
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Email address
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Your email
Do You Have Health Insurance?
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No
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Full Name
Your answer
Age
Your answer
Cell Phone Number
This information is required to communicate any updates, if any.
Your answer
1st Time Preference
11:00AM to 11:30AM
11:30AM to 12:00PM
12:00PM to 12:30PM
12:30PM to 1:00PM
1:00PM to 1:30PM
1:30PM to 2:00PM
2:00PM to 2:30PM
2:30PM to 3:00PM
3:00PM to 3:30PM
2nd Time Preference
11:00AM to 11:30AM
11:30AM to 12:00PM
12:00PM to 12:30PM
12:30PM to 1:00PM
1:00PM to 1:30PM
1:30PM to 2:00PM
2:00PM to 2:30PM
2:30PM to 3:00PM
3:00PM to 3:30PM
Feedback/Comments
Your answer
š„ SELF-QUARANTINE QUESTIONNAIRE
ā If you answer YES to any of the following questions, please see a medical professional and REFRAIN from coming. š
šŖ Have you or anyone in your household had any of the following symptoms in the last 21 days: sore throat, cough, chills, body aches for unknown reasons, shortness of breath for unknown reasons, loss of smell, loss of taste, runny nose, fever at or greater than 100 degrees Fahrenheit?
š§ Have you or anyone in your household been tested for COVID-19?
š„ Have you or anyone in your household visited or received treatment in a hospital, nursing home, long-term care, or other health care facility in the past 30 days?
š¦ Have you or anyone in your household traveled on a cruise ship in the last 21 days?
š§ Are you or anyone in your household a health care provider or emergency responder?
šŖ Have you or anyone in your household cared for an individual, who is in quarantine or is a presumptive positive or has tested positive for COVID-19?
šØ Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19?
š« To the best of your knowledge have you been in close proximity to any individual who tested positive for COVID-19?
A copy of your responses will be emailed to the address you provided.
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