Schedule a Vaccination

Vaccinations are available Monday through Friday, 10 PM to 4 PM.

Please, have your insurance card with you.
If you are a Medicare patient, bring your Part B card and your prescription coverage card.
It is very important to be on-time and dress appropriately. 
We are able to administer shots to individuals 12 years and older.

We are not currently not administering the Covid-19 Vaccine.


Patient Information

First Name*
Last Name*
Date of Birth (MM/DD/YYYY)*
Age*
Gender
Please Choose...
Email*
Contact Phone Number*
Home Address*
Address Line 2
City*
State
Zip Code*
Primary Care Physician
Physician Phone
Insurance Card
Upload an image of your insurance card or bring it to your appointment.
Vaccines To Receive At Your Appointment (Max 2)
Vaccines To Receive At Your Appointment (Max 2)

Screening Questionaire

The following questions will help us deermine your eligibility to be vaccinated.
Are you feeling sick or experiencing a moderate to high fever?
Are you feeling sick or experiencing a moderate to high fever?
Do you have any allergies to medications, food (i.e. eggs), latex, vaccine component (i.e. neomycin, formaldehyde, gentamicin, thimerosal, bovine protien, phenol, polymyxin, gelatin, baker's yeast etc.) If yes, please list.
Do you have any allergies to medications, food (i.e. eggs), latex, vaccine component (i.e. neomycin, formaldehyde, gentamicin, thimerosal, bovine protien, phenol, polymyxin, gelatin, baker's yeast etc.) If yes, please list.
Have you ever had a serious reaction to any vaccinations, including fainting and feeling dizzy?
Have you ever had a serious reaction to any vaccinations, including fainting and feeling dizzy?
Have you ever had a health problem with lung, heart, kidney or metabolic disease (e.g. diabetes), asthma, or a blood disorder? If yes, please list.
Have you ever had a health problem with lung, heart, kidney or metabolic disease (e.g. diabetes), asthma, or a blood disorder? If yes, please list.
Have you ever had a seizure disorder for which you were on seizure medication(s), a brain disorder, Guillain-Barre Syndrome (a condition that causes paralysis) or other nervous system conditions?
Have you ever had a seizure disorder for which you were on seizure medication(s), a brain disorder, Guillain-Barre Syndrome (a condition that causes paralysis) or other nervous system conditions?
For women: Are you pregnant or considering becoming pregnant in the next month?
For women: Are you pregnant or considering becoming pregnant in the next month?

Have you had the following vaccines?

Pneumococcal Vaccine
Have you had the Pneumococcal Vaccine?
Shingles Vaccine
Have you had the Shingles Vaccine ?
Tdap (Whooping cough) Vaccine
Have you had the Tdap (Whooping cough) Vaccine?

Schedule Vaccination

Vaccinations are available from 10 AM - 4PM, Monday - Friday. Not available on federal holidays. Please choose a time for your appointment. IF ALL TIMES SLOTS ARE NOT HIGHLIGHTED OR CLICKABLE THAT MEANS WE ARE COMPLETELY BOOKED OUT.
Fri, Sep 30
Fri, Sep 30
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
01:00 PM
01:15 PM
01:30 PM
01:45 PM
02:00 PM
02:15 PM
02:30 PM
02:45 PM
03:00 PM
03:15 PM
03:30 PM
03:45 PM
Weekend
Mon, Oct 3
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
01:00 PM
01:15 PM
01:30 PM
01:45 PM
02:00 PM
02:15 PM
02:30 PM
02:45 PM
03:00 PM
03:15 PM
03:30 PM
03:45 PM
Tue, Oct 4
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
01:00 PM
01:15 PM
01:30 PM
01:45 PM
02:00 PM
02:15 PM
02:30 PM
02:45 PM
03:00 PM
03:15 PM
03:30 PM
03:45 PM
Wed, Oct 5
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
01:00 PM
01:15 PM
01:30 PM
01:45 PM
02:00 PM
02:15 PM
02:30 PM
02:45 PM
03:00 PM
03:15 PM
03:30 PM
03:45 PM
Thu, Oct 6
10:00 AM
10:15 AM
10:30 AM
10:45 AM
11:00 AM
11:15 AM
11:30 AM
11:45 AM
12:00 PM
12:15 PM
12:30 PM
12:45 PM
01:00 PM
01:15 PM
01:30 PM
01:45 PM
02:00 PM
02:15 PM
02:30 PM
02:45 PM
03:00 PM
03:15 PM
03:30 PM
03:45 PM

PATIENT AGREEMENT AND CERTIFICATION

Signature (type your full name)*
Date