COVID-19 Vaccine Pre-Registration
Please Note: At this time, you can call the pharmacy to sign up for a vaccine appointment. However, if you would prefer, you can fill out this form to pre-register for the COVID-19 vaccine FIRST DOSES. Do not sign up for second doses, third doses or boosters on this list. We will get in touch with you as soon as possible to get you vaccinated. Thank you!
Name *
Email *
Phone number *
Address *
Date of Birth *
Which pharmacy would you like to visit? *
Any other comment or note you would like to make?
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