• Ballweg Family Pharmacy COVID Vaccination Request Form

    Ballweg Family Pharmacy Vaccination Request Form. Please note that completing this form does not guarantee that you will receive vaccine. The team from Ballweg Family Pharmacy will contact you via email or phone to notify you when you are eligible to book your vaccine appointment as the vaccine becomes available. If you are filling this form out for additional family members over 18 years of age, please fill out ONE FORM PER PERSON. The vaccines will be provided at no cost to the patient.
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  • Because the supply of COVID-19 vaccine in the United States is expected to be limited at first, the CDC is providing recommendations to federal, state, and local governments about who should be vaccinated first. CDC’s recommendations are based on recommendations from the Advisory Committee on Immunization Practices (ACIP), an independent panel of medical and public health experts. The recommendations were made with these goals in mind: *Decrease death and serious disease as much as possible. *Preserve functioning of society. *Reduce the extra burden COVID-19 is having on people already facing disparities. * * Center Pharmacy will follow the Wisconsin COVID-19 Vaccination Phase guidance: https://www.dhs.wisconsin.gov/covid-19/vaccine-about.htm

  • **This phasing is an interim vaccine plan from the department. Many components of the COVID-19 vaccine plan remain fluid and continue to be modified and adapted as more announcements and decisions are made at the federal level. The department is continuing to receive feedback and will be modifying this plan and posting public updates to this in the coming weeks.** *

  • DISCLAIMER: please note that your submission of a response to this survey does not guarantee that you will receive a vaccine. We are following the strict CDC and WI DHS guidelines on prioritization of vaccination. We kindly ask that you do not contact the pharmacy for an update on when you will be getting your vaccine. We assure you that you will be contacted AS SOON AS you are eligible for the vaccine - and we have vaccine in stock. THANK YOU for your patience and understanding! *

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