Margiotti & Kroll Covid-19 Vaccine Wait List
Sign in to Google to save your progress. Learn more
Email *
Please note that due to the storage requirements associated with the different vaccines, Margiotti & Kroll Pediatrics is presently only administering the Moderna vaccine.  This vaccine is only approved for people 18 years of age and older.                      **Are you OVER the age of 18?** *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy