Cancel or Reschedule My Vaccine Appointment
We understand things may come up or you might not be feeling well & that you would like to cancel your vaccine appointment. We appreciate you informing us and requesting to cancel that appointment, making room for someone else to take that vaccine appointment slot. Please note, filling this out does not automatically cancel your appointment in our system right away, our team will take care of the cancellation but you may still get an automated vaccine appointment reminder (please ignore that). If you would like to reschedule for a different date and time please put in the comments section below.
Patient Name
*
First Name
Last Name
2nd Patient Name (If applicable)
First Name
Last Name
3rd Patient Name (If applicable)
First Name
Last Name
4th Patient Name (If applicable)
First Name
Last Name
What Date Was Your Appointment For?
-
Month
-
Day
Year
Date
Which Vaccine(s) Did You Have an Appointment For That You'd Like to Cancel?
*
COVID-19, Moderna 12+
COVID-19, Pfizer 12+
COVID-19, Moderna 6mo-11yrs
COVID-19 Pfizer 5-11yrs
COVID-19, Pfizer 6mo-4yrs
COVID-19, Novavax
Flu, FLUCELVAX, 3-64
Flu, FLUAD, 65+
RSV (Respiratory Synctial Virus), 60+
RSV (Respiratory Synctial Virus), ABRYSVO, Pregnant
Shingles, SHINGRIX, 1st Dose, 50+
Shingles, SHINGRIX, 2nd Dose, 50+, 2-6 months after 1st dose
Pneumonia, PREVNAR 20, 65+ or 19-64 (Immunocompromised)
Pneumonia, PNEUMOVAX, 65+ or 19-64 (Immunocompromised)
Hepatitis B, ENGERIX B, 1st Dose, 18+
Hepatitis B, ENGERIX B, 2nd Dose (1 month after 1st dose)
Hepatitis B, ENGERIX B, 3rd Dose (6 months after 2nd dose)
Hepatitis A & B, TWINRIX, 18+
Typhoid, TYPHIM, Age 18+ (at least 2 weeks prior to expected exposure)
Boostrix (Tdap - Whooping Cough), 18+
What is the Reason for Cancellation?
*
I would like to reschedule my appointment(s) - please put new date & time in comments below.
I or a family member contracted COVID-19 or are not feeling well.
Something came up and I can no longer make it.
I received my vaccine elsewhere.
I no longer want to receive the vaccine.
I cannot make it - I will reschedule later.
I booked a duplicate appointment.
I already received my vaccine through you.
Other
Any comments (if rescheduling, new date & time you'd like the appointment(s) for
Submit
Should be Empty: