Cancel or Reschedule My Vaccine Appointment
Need to cancel or reschedule your vaccine appointment? Complete this quick form and our team will update your appointment as soon as possible. If requesting a new date/time, please include your preferred reschedule details in the comments section .Submitting this form does not cancel your appointment immediately. Our team will process the cancellation shortly, and any reminder texts/emails received in the meantime can be ignored.
Patient Name
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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?
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Month
-
Day
Year
Date
Which Vaccine(s) Did You Have an Appointment For That You'd Like to Cancel?
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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?
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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: