Drayton Valley Value Drug Mart COVID-19 Vaccine Registration Form
Thank you for your interest in the COVID-19 vaccine. We are currently still vaccinating the 2A category and not taking a waitlist for 2B at this time due to delay in vaccine supply. We appreciate your patience!
Alberta Health Care Number
Please enter a valid phone number.
Health and Medical History
Please list your allergies.
Have you had ANY vaccines in the last 14 days?
Please check the symptoms that apply
Loss of taste or smell
Difficulty in breathing
Persistant pain or pressure on chest
NONE OF THE ABOVE
Have you been diagnosed with COVID-19?
I hereby declare that all the given information are accurate.
If you have any questions please call us at 780 542 5366.
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