MODERNA VACCINE SIGNUP
Forest Heights Pharmacy 4439 County Club Rd. Statesboro, Ga 30458 Phone: 912.489.7979.
Date of Birth
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Which of the following qualifies you for a vaccine under the state of Georgia requirements?
Over the age of 18 years old (currently we only have the Moderna vaccine which requires you to be 18 years old)
IF YOU DO NOT HAVE YOUR MEDICARE ID, PLEASE USE YOUR SOCIAL.
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Are you a Georgia resident or do you work in the state of Georgia?
Have you had any other vaccines in the past 14 days.
Yes, I have had another vaccine and therefore I am not eligible.
No, I have not had another vaccine
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