Join our Moderna COVID-19 Waiting List
We are currently booked for the allocated COVID-19 Moderna doses we have received, but you may sign-up to be on our waiting list.  Submitting this form is the quickest and easiest way to be added to our list.

Please note the following:

- While we love hearing from you, please refrain from calling the pharmacy at this time.  We are experiencing a high volume of calls about the vaccine, creating delays in the vaccine process. Do feel free to email us at goodlarkvaccine@gmail.com.

- If you called earlier in the week before our waitlist was available online, we still have your information and position from earlier this week.  Please do not resubmit an application.

- We encourage patients to sign up on other waiting lists and continue to search for appointments at other COVID vaccine locations.

- Joining the waitlist does not guarantee a vaccine from Goodlark Pharmacy at Fairview.

- Submit a form for each individual (for example - husband and wife will have to complete this form twice).  If you do not have an email, you are welcome to use goodlarkvaccine@gmail.com.  Please use your contact information for the rest of the form.

- You do not have to be a Williamson County Resident to receive the vaccine, but you must meet the criteria for Williamson County at https://covid19.tn.gov/covid-19-vaccines/county-vaccine-information at the time of your vaccination appointment.

- If you do have questions or would like more information, we welcome your email at goodlarkvaccine@gmail.com.  This is the quickest way to receive answers to your questions or information you'd like to request.

Enter your email address below to receive a confirmation of your waiting list entry.  Once you submit this form, you WILL be placed on our waiting list.  Thank you!
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Email *
Please Enter Your First and Last Name *
Please Enter Your Phone Number *
Include the area code
Please Enter Your Birthdate *
Enter in MM-DD-YYYY Format
Please Enter Your City and Zip Code *
You do not have to be a Williamson County Resident to receive the vaccine, but you must meet the criteria for Williamson County at https://covid19.tn.gov/covid-19-vaccines/county-vaccine-information at the time of your vaccination appointment.
Please select which population best defines you: *
You may select more than 1
Have you tested positive for COVID-19 in the past 90 days? *
Have you already received your first COVID-19 shot? *
Have you received any vaccinations in the past 14 days? *
Example: Flu Vaccine, Shingles Shot, etc
(Optional) Is there any other information you would like us to know?
FOR NEARBY ELIGIBLE RESIDENTS ONLY
If you are within 15 minutes of our pharmacy (2340 Fairview Boulevard) and have a flexible schedule, are you available for a last minute appointment?
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A copy of your responses will be emailed to the address you provided.
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