Freehold Area Health Department, Freehold Twp. Vaccine Clinic
January 19th at 3-5pm
Freehold Twp. Municipal Bldg. Room 114
One Municipal Plaza, Freehold

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* 1. What is your last name?

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* 2. What is your first name?

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* 3. How old are you?

5-11 years

12-18 years

> 18 years

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* 4. All children ages 5-17 must receive the Pfizer vaccine. Adults 18 and over may choose Pfizer, Moderna or J&J (Janssen). Which vaccine shall we reserve?

Children's Pfizer (ages 5-11)

Adult Pfizer (ages 12+)

Moderna

Janssen

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* 5. What is your phone number?

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* 6. What is your email address?

Please note that this will be used to notify you of any changes or cancellation.

You will not receive an appointment confirmation by email.