Interested in one of the newest flu vaccine options at Skippack Pharmacy?
We already have our traditional flu vaccine options available, including Flucelvax (6mo-64 years), Fluad 65+ (senior dose), and mFlu (Moderna's new flu vaccine).This interest form is specifically for patients who would like to be notified when we receive FluMist — the needle-free nasal spray flu vaccine. Complete this short form and we’ll let you know when the option you’re interested in becomes available. Looking for a regular flu shot now? No need to complete this form — Flucelvax, Fluad, and mFlu (Moderna) are already available at Skippack Pharmacy. Walk in or schedule at www.SkippackPharmacy.com/flu. This form is for interest/notification only and does not reserve a vaccine or appointment.
Your Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Your Email Address
*
We’ll use this email to send vaccine availability and scheduling information.
How many people in your household are you interested in having vaccinated?
1
2
3
4
5+
Who are you interested in getting vaccinated? SELECT ALL THAT APPLY
Age 5–11 years
Age 12–17 years
Age 18–64 years
Age 65+
Which 2026–27 FLU vaccine(s) would you like to be notified about? SELECT ALL THAT APPLY
FluMist — the needle-free nasal spray flu vaccine
Please put anything else we should know or you'd like to tell us below. Thank you!
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