• FAIRLEY'S VACCINE APPOINTMENT FORM

  • My Products*

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    COVID VACCINE- PFIZER COMIRNATY. COVERED 100% FOR MOST INSURANCE. 12 YEARS AND OLDER
    COVID VACCINE- PFIZER COMIRNATY

    COVERED 100% FOR MOST INSURANCE.  12 YEARS AND OLDER

    $165.00$165.00
      
    COVID VACCINE- MODERNA SPIKEVAX. COVERED 100% FOR MOST INSURANCE. 12 YEARS AND OLDER
    COVID VACCINE- MODERNA SPIKEVAX

    COVERED 100% FOR MOST INSURANCE.  12 YEARS AND OLDER

    $165.00$165.00
      
    COVID VACCINE- MODERNA SPIKEVAX PEDIATRIC. COVERED 100% FOR MOST INSURANCE. 7 TO 11 YEARS
    COVID VACCINE- MODERNA SPIKEVAX PEDIATRIC

    COVERED 100% FOR MOST INSURANCE.  7 TO 11 YEARS

    $165.00$165.00
      
    COVID VACCINE- MODERNA MNEXSPIKE. COVERED 100% FOR MOST INSURANCE. 12 YEARS AND OLDER
    COVID VACCINE- MODERNA MNEXSPIKE

    COVERED 100% FOR MOST INSURANCE.  12 YEARS AND OLDER

    $200.00$200.00
      
    FLU VACCINE - FLUAD. COVERED 100% BY MOST INSURANCE, HIGH DOSE 65 YEARS AND OLDER
    FLU VACCINE - FLUAD

    COVERED 100% BY MOST INSURANCE, HIGH DOSE 65 YEARS AND OLDER

    Free$ Free
      
    FLU VACCINE - FLUCELVAX. COVERED 100% BY MOST INSURANCE, 7 YEARS TO 64 YEARS
    FLU VACCINE - FLUCELVAX

    COVERED 100% BY MOST INSURANCE, 7 YEARS TO 64 YEARS

    Free$ Free
      
    SHINGLES VACCINE - SHINGRIX. COVERED BY MOST INSURANCE WITH COPAY - 50 YEARS AND OLDER
    SHINGLES VACCINE - SHINGRIX

    COVERED BY MOST INSURANCE WITH COPAY - 50 YEARS AND OLDER

    $220.00$220.00
      
    TETANUS, DIPTHERIA, PERTUSIS - BOOSTRIX Product Image
    TETANUS, DIPTHERIA, PERTUSIS - BOOSTRIX
    $80.00$80.00
      
    PNEUMONIA - PNEUMOVAX Product Image
    PNEUMONIA - PNEUMOVAX
    $130.00$130.00
      
    PNEUMONIA - PREVNAR20 Product Image
    PNEUMONIA - PREVNAR20


    $200.00$200.00
      
    RSV - ABRYSVO Product Image
    RSV - ABRYSVO
    $220.00$220.00
      
    Total
    $0.00$0.00
  • Format: (000) 000-0000.
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