Riverside Medical Group has very limited supply of the Moderna COVID-19 vaccine. Unfortunately, we do not have appointments available for first doses at this time. Please complete the form below to be added to our wait list. Riverside is only offering COVID-19 vaccine to those who fall into the eligible groups identified by the New Jersey Department of Health -https://www.nj.gov/health/
Please fill out the following information and you will be contacted by Riverside Medical Group staff member to schedule an appointment as vaccines become available. Due to high demand we cannot guarantee you will be contacted.
Date of Birth
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Policy Holder Name
Policy Holder Date of Birth
Are you interested in seeing a Primary Care Provider for Yearly Wellness Exam?
I agree to terms & conditions. NOTICE OF PRIVACY PRACTICES RECEIPT RIVERSIDE MEDICAL GROUP, I acknowledge the Riverside Medical Group Notice of Privacy Practices. I also acknowledge that future revisions of this notice will be available on the Riverside website www.riversidemedgroup.com or upon request. This pertains to the HIPAA - NOTICE OF PRIVACY ACT GUIDELINES.
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