2024-2025 NEW COVID-19 Vaccine Interest Form
Skippack Pharmacy & the COVID Task Force have been at the forefront of vaccine administration over the past 4 years having provided over 100,000 COVID-19 vaccines at off-site clinics at schools, churches, pop-up clinics and at the pharmacy's one-of-a-kind immunization center. As of September 3rd, we CURRENTLY have Pfizer & Moderna for 5+ -- you can schedule an appointment on our website. We are awaiting to receive FLUMIST, NOVAVAX & BABIES PFIZER/BABIES MODERNA vaccines. Please fill out this form out if you would like to be informed when these vaccines arrive at Skippack Pharmacy.
Your Name
*
First Name
Last Name
Your Email Address
*
An email address we will send the appointment links & clinic information to.
Which vaccine are you interested in that we do not currently have in stock?
*
Novavax 12+
Baby Pfizer (6 months-2 years)
Baby Moderna (6 months-2 years)
Flumist (3 years - 49 years)
Where would you prefer to receive the vaccine? If indifferent, can leave blank **If you would like to have our team come off-site for a clinic, please sign up your site on our website: www.SkippackPharmacy.com/mobilevax**
Skippack Pharmacy's Immunization Center
Clinic at Church
Clinic at Township Building
Clinic at Business
Clinic at Organization
Clinic at School District
Anything else we should know or you'd like to tell us?
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