FMS Pharmacy COVID-19 Vaccine Wait List
Please answer the questions below in order to be on standby for a COVID-19 Vaccine with FMS Pharmacy. You may be contacted to come and receive a vaccine with short notice or be on standby for next vaccine.
First Name *
Last Name *
Date of Birth
MM
/
DD
/
YYYY
Place of Work/ Occupation
Phone Number *
Email
Submit
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