IMPORTANT: 

Only If you have successfully scheduled for COVID Vaccine on STEP 1; please complete following consent form for COVID vaccine and arrive at the pharmacy at a designated time with Prescription insurance card.

 

Note: If you are not able to schedule vaccine in STEP 1, your consent form will be automatically deleted from the system. Please revisit when scheduler is open for new appointments. 

https://hipaa.jotform.com/210844457590157