COVID-19 Vaccine Forms & Information

Please download, print, and bring a completed COVID-19 Immunization Consent Form, or the COVID-19 Booster Form and Pfizer Attestation Form with you for your appointment. The Moderna COVID-19 Vaccine Fact Sheet includes information about the COVID-19 vaccine we are administering. The V-safe After Vaccination Health Checker helps you monitor your health after receiving the COVID-19 Vaccine. Thank you.

COVID-19 Booster Consent Form

Pfizer Booster Attestation Form

Bivalent COVID-19 Consent Form

COVID-19 Immunization Consent Form

Moderna COVID-19 Vaccine Fact Sheet

V-safe After Vaccination Health Checker

Vaccine Waiting List

TO BE ADDED TO THE WALTMIRE PHARMACY WAITING LIST:

Please email us at waltmirepharmacycovid19@yahoo.com to be added to our waiting list. Being on our waiting list does not guarantee we will be able to vaccinate everyone. We will make every effort to vaccinate as many patients as soon as we can, which is directly affected by the number of shots we receive from the department of health. All Covid-19 vaccines will be given by appointment only, we will notify you when we are ready to make an appointment for you, please do call the store or send more than one email as this will slow the process.

**Please do not call the store or send more than one email as this slows down the process**

Thanks for your desire to get vaccinated and your continued efforts to wear a mask and social distance until we can work our way out of this Pandemic.