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FMS Pharmacy COVID-19 Vaccine Wait List
Please answer the questions below in order to be on standby for a COVID-19 Vaccine with FMS Pharmacy. You may be contacted to come and receive a vaccine with short notice or be on standby for next vaccine.
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Date of Birth
MM
/
DD
/
YYYY
Place of Work/ Occupation
Your answer
Phone Number
*
Your answer
Email
Your answer
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