Rodman's Online Vaccination Appointment Form

Rodman's Pharmacy

5100 Wisconsin Ave NW

Washington, DC 20016

pharmacy@rodmans.com

www.rodmans.com

(202) 363-3466
Rodman's Vaccination Appointment Form

Fill the form below and we will email you a confirmation of your appointment.
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Gender*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Have you been vaccinated at our pharmacy before?*

YesNo
Which vaccine are you looking to receive?*
Vacination Scheduling

Due to Vaccine supply we have limited availability. Every Monday at 10:00am we open scheduling for the following week. If no slots are currently available please check back next Monday.
Preferred Vaccination Date *
Should be Empty:

Rodman's Vaccination Appointment Form