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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?

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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?

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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.

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