Tarrytown Pharmacy: COVID-19 Vaccine

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This is a communication list form, so Tarrytown Pharmacy can alert you when the COVID-19 Vaccine is available and whether or not you qualify to receive one at that time. Please answer the questions as applicable to you.

Tarrytown Pharmacy is NOT liable for promising when the vaccine will be available for wide administration.

Please state which of the following apply to you: (If more than one apply, choose only the first option in chronological order) *

I am a healthcare employee or professional (I work in one of the following: hospitals, long-term care facilities, outpatient clinics, home health care, pharmacies, emergency medical services, or public health)

I am a resident of a long term care facility (skilled nursing facility, assisted living facility, or other residential care)

I am an essential worker (ie. education sector, food & agriculture, utilities, police, firefighter, correction officers, and transportation)

I am greater than 65 years of age

I have high-risk medical condition (i.e. cancer, chronic kidney disease, COPD, diabetes, heart conditions such as heart failure, coronary artery disease, or cardiomyopathies, obesity, (BMI > 30 kg/m2), pregnancy, sickle cell disease, and/or smoking)

I do not apply to any of these categories

I have ALREADY previously received a first dose of MODERNA, and am looking for a SECOND dose.

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