• Kensington Library Vaccine Registration

    October 19th 2026 from 3 PM - 5:30 PM

  • No appointments required - first come, first served!

     

    Thank you for trusting Parkway Pharmacy, your local independent pharmacy, for your seasonal vaccines! We are committed to making this process as convenient as possible. Questions? Give us a call at 215-642-2422.

  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Gender*
  • Format: (000) 000-0000.

  • Commercial Insurance

    IF YOU HAVE MEDICARE, PLEASE SELECT MEDICARE UNDER TYPE OF INSURANCE ON PREVIOUS PAGE.
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  • Insurance Information

    Please fill this out if you cannot upload a photo of your insurance card.

  • Medicare

    IF YOU DO NOT HAVE MEDICARE, PLEASE SELECT COMMERCIAL UNDER TYPE OF INSURANCE ON PREVIOUS PAGE.
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  • Medicare Information

    Please fill this out if you cannot upload a photo of your Medicare card.

  • Medical History

  • Do you have allergies to latex, food, medications, or vaccine components? (such as eggs, thimerosal, gelatin, neomycin, phenol, or bovine protein)?*
    Rows
  • Do you have any of the followings? (select all that apply)*
  • Do you have an immunocompromised condition? (select all that apply)*
  • Do you have any of the following?*

  • Vaccine Information

    Please see each vaccine for pricing
  • Which vaccine(s) are you getting today?*
  • Has it been at least 4 months since your last COVID booster?*

  • Vaccine Information

  • Which vaccine(s) are you getting today?*
  • Has it been at least 4 months since your last COVID booster?*
  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • By signing this form, I hereby accept that I have read and acknowledged the waiver provided above. I declare that the information I have provided is correct. I am giving my full consent to get vaccinate of my own will.

  • FOR OFFICE USE ONLY

  • VACCINATING PHARMACISTS

    Dennis Czerw, PharmD (NPI: 1154958742)

    Gina Lee, PharmD (NPI: 1720895261)

     

    VACCINE NDCs

    FluAD 70461002503

    Flucelvax 70461065503

    Afluria 33332002503

    mNEXSPIKE 8077740060

    Spikevax 8077711296

    Spikevax (Peds) 8077711380

    Comirnaty 0069252810

    Abrysvo 00069034401

    Mresvia 80777034596

    Shingrix 58160082311

    Prevar20 00005200002

    Boostrix 58160084252

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