PLEASE SELECT EITHER MODERNA OR J&J VACCINE BELOW
**SUBJECT TO AVAILABILITY**
WE DO NOT ADMINISTER THE PFIZER VACCINE
Your vaccine appointment will be at:
44 South White Horse Pike
Hammonton, New Jersey 08037
If you have remaining questions, please call us at (609) 956-1900
Section I. Personal Information
Section II. Questionnaire for Immunization
The following questions will help us determine if there is any reason you should not get the COVID-19 vaccine. If you answer "yes" to any question, it does not necessarily mean you may not be vaccinated. It just means additional questions may be asked. If a question is not clear, please ask your healthcare provider.
Section III. Appointment Scheduler
**Vaccine supply is limited. Please keep your appointment or call if you need to cancel or change it. Additionally, due to vaccine requirements, we may call you to see if you can come earlier, later or to a nearby location. If you miss an appointment, no doses will be held to guarantee your dose.**
Section IV. Supporting Documents
Emergency Use Authorization of the Moderna Covid-19 Vaccine
Emergency Use Authorization of the Janssen/J&J Covid-19 Vaccine
I understand that the pharmacy cannot guarantee that a vaccine dose will be available on the date and time that I scheduled my appointment.
Our staff will be in contact should changes need to be made.
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