COVID-19 Vaccine Waitlist Form
Patients on this list MUST be 18 years old or up. Patients on this list may be called at a moments notice and agree to make every effort to come to the pharmacy as soon as possible if a vaccine dose is available. We ask if you are on the list and have received the Covid-19 vaccine from another provider, please call to let us know so we can remove your name from our list. This will allow us to quickly call the next person in line. Thank you for helping to support our vaccine outreach to our community. Maggy Pharmacy currently carries Covid-19 vaccines approved for use in ages 18 and up.
Please indicate what vaccine you are looking to receive
Moderna- 2 shots 28 days apart
Johnson & Johnson- 1 shot only
Date of Birth
Please enter a valid phone number.
Street Address Line 2
State / Province
Postal / Zip Code
Please let us know approximately how long it would take you, from where you live, to get to Maggy Pharmacy.
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