South 26/27

Vaccine Appointments

This is for Kilgore's Medical Pharmacy on Chapel Hill Rd
Kilgore's Employee Use Only
Vaccine(s) Requested: you can select both if you'd like to get them on the same day.
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
CDC's immunization schedules have been updated to support individual decision-making for COVID-19 vaccination, based on consultation with a doctor, nurse, pharmacist, or other provider who can advise according to a patient's risk factors and other characteristics. The recommendation from the Advisory Committee for Immunization Practices (ACIP) holds that, in the population aged 64 years and younger, vaccine benefit is greatest for those with higher risk for COVID-19 and lowest for those not at increased risk due to comorbidities or other predictors.
Moderna's COVID Vaccine has only been approved for individuals 65+ or Individuals 6 months-old to 64 years-old with at least one underlying condition that puts them at increased risk for COVID-19. Please contact the store with questions.
If you would still like to get a flu shot, please back to the top and un-select "Covid"
Because you are age 65 or older, we recommend you get a High-Dose Flu Vaccine. If you would prefer to get the Regular Flu Vaccine instead, please indicate below.
Gender
Phone Number
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Appointment
Calculation for appointment
Flu Vaccine
Directions 1
Qty 1
Covid Vaccine
Directions 2
Qty 2
Date Written

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Pharmacist/Prescriber
Should be Empty:

Vaccine Appointments