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VACCINE SCHEDULING
Vine Pharmacy
* Indicates required question
FULL NAME
*
(As it appears on your Medicare/Insurance card)
Your answer
DATE OF BIRTH
*
(MM/DD/YYYY)
Your answer
PHONE NUMBER
*
(###-###-####)
Your answer
SELECT WHICH VACCINE YOU WOULD LIKE TO RECIEVE
*
COVID-19
Flu
Pneumonia
Shingles
Other vaccine
NOTE: You may receive multiple vaccines at the same appointment, please select one of the options above to continue scheduling.
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