COVID-19 Vaccine Appointment Scheduling and Consent Form  Logo
  • MEdicare expects to laod the 2025 Meidcare Part D plans into their comparison tool by October 21. Plan reviews will not be available until then.

  • Medicare Open Enrollment Period runs October 15 through December 7.

    Patients who have never enrolled in Part D plans or are turning 65 in the next 3 months can enroll in a plan at any time.

    Patients who have a Low Income Subsidy (LIS) or are enrolled in New Jersey PAAD may change their enrollment at any time during the year.

    All other patients need to wait for the Open Enrollment Period to change Medicare Part D Plans.

  • Because Shingles is caused by a dormant Chickenpox infections, you are NOT AT RISK FOR A SHINGLES OUTBREAK.

    You do not qualify for a Shingles vaccination.

    Thank you for taking the time to protect yourself and your health.

  • The CDC recommends RSV vaccination be determined with consultation with your provider.

    RSV vaccination in older adults should be targeted to those who are at highest risk for severe RSV disease.

    Please consult with your provider. If you wish to receive the RSV vaccine, please call and will schedule an appointment.

  • COVID Vaccine is currently out of stock.

    We will update the scheduler when it is avaiable.

  • We are currently offering only

    MODERNA COVID VACCINE.

     

  • We only offer the Pfizer brand

    COVID vaccine (Comirnaty).

  • Flu Testing is available to patients from 6 to 80 years of age who have been experiencing symptoms for no more than 72 hours (3 Days).

    Influenza causes an increase in body temperature. If a patient does not have a fever or "feel feverish" without the use of medications to reduce fever, there is no need for a test and we will not be able to test for Flu. 

  • We offer all COVID-19 Vaccines from all manufacturers:

     Pfizer, Moderna, and Johnson & Johnson (Jannsen).

     

  • Influenza Vaccine is recommended for all patients 6 months of age and older.

    Influenza Vaccine can be administered at the same time as COVID-19 Vaccine, RSV Vaccine or Pneumonia Vaccine.

    The 2024-2025 Flu vaccines are now expired.

  • The 2025-2026 influenza vaccine should be available in mid-August.

  • We are unable to schedule appointments for Influenza vaccinations prior to Sept 12, 2022 at this time.

    If you require the vaccination prior to that date, please check back at another time for updated vaccine delivery dates.

  • Consent Form

  • CHOOSE FROM ONE COLUMN BELOW

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  • 0.5cc

  • BOOSTER

    0.25cc

  • We do not have that manufacturer's COVID-19 vaccine at this time. Please choose another.

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  • Minimum age for vaccination at the pharmacy is 8.

  • RSV vaccination is only approved for patients at least 60 years of age.

  • Minimum age for Shingles vaccination at the pharmacy is 50 years of age.

  • EUA/VIS: 09/21/23

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  • 0.3cc

  • 0.5cc

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  • INSURANCE INFORMATION

  • Bayshore Pharmacy is not credentialed for your Insurance for Footwear for Diabetics,

    Reach out to your insurance company for the nearest Network Provider.

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  • PCR COVID TESTING

  • This specimen was provided voluntarily for analysis and I authorize the laboratory to process, bill and provide results. I authorize the release to my insurance carrier of any medical information necessary to process this claim, and I authorize payment of medical benefits directly to Prophase Diagnostics.
    I agree to the declarations and terms in the patient acknowledgment and irrevocable assignment of benefits.I understand that if do not have insurance, I will be billed directly by Prophase Diagnostics. I also authorize release of my results to my doctor utilizing all methods of transmission according to HIPAA regulations. De- identified patient data may be used for R&D purposes. 

    I acknowledge that documentation to support medical necessity for all tests ordered is recorded in the patient's chart. If not signed, Authorized Healthcare Provider affirms that test orders are placed in patient file with provider signature and will be available upon request. The Office of the Inspector General requires documentation in patient medical chart including date of service, tests ordered and documentation to support medical necessity.

  • RAPID POINT OF CARE TESTING

  • Point Of Care testing at the pharmacy is available only to patients 13 years of age or older. Please reach out to your pediatrician for testing.

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  • POINT OF CARE TESTING

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  • Flu Testing is available to patients from 6 to 80 years of age who have been experiencing symptoms for no more than 72 hours (3 Days).

    Influenza causes an increase in body temperature. If a patient does not have a fever or "feel feverish" without the use of medications to reduce fever, we will not be able to perform a test. 

    Please review your answers and symptoms for accuracy or contact your physician for followup.

  • A1C Tests performed in the pharmacy are only approved for diabetic patients. Please reach out to your physician for more information about A1C testing.

  • prevnext( X )
    Blood Pressure Check Product Image
    Blood Pressure CheckOur staff will take a blood pressure reading . Results can be sent to your provider upon your request.
    $9.50
      
    Omega-3 Test  Product Image
    Omega-3 Test Finger-stick blood test for Omega-3 Level. Test will be sent to our lab with results returned in about a week.
    $49.95
      
    Vitamin-D Test Product Image
    Vitamin-D TestFinger-stick blood test for Omega-3 Level. Test will be sent to our lab with results returned in about a week.
    $54.95
      
    A1C Test Product Image
    A1C TestThe A1C test is a blood test that provides information about your average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is also the primary test used for diabetes management.
    $29.95
      
    Rapid RSV Test Product Image
    Rapid RSV TestA rapid RSV test, or rapid Respiratory Syncytial Virus antigen test, is a common test that can quickly detect an RSV infection. Results are available in 15 minutes.
    $19.95
      
    Rapid Strep Test Product Image
    Rapid Strep TestA rapid Strep test, or rapid Respiratory Syncytial Virus antigen test, is a common test that can quickly detect an RSV infection. Results are available in 15 minutes.
    $24.95
      
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    Credit Card

  • This test has not been FDA cleared or approved; This test has been authorized by FDA under an EUA for use by authorized laboratories; This test has been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens; and, This test is only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b1) of the Act, 21 U.S.C. § 360bbb-3(b1 unless the authorization is terminated or revoked sooner.

  • This tests have not been FDA cleared or approved; This test has been authorized by FDA under an EUA for use by authorized laboratories; These tests have been authorized only for the detection of proteins from SARS-CoV-2, not for any other viruses or pathogens; and, These tests are only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostics for detection and/or diagnosis of COVID-19 under Section 564(b1) of the Act, 21 U.S.C. § 360bbb-3(b1 unless the authorization is terminated or revoked sooner. This test uses a small sample of blood from a finger stick.

  • INFLUENZA/PNEUMONIA VACCINATIONS

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  • VACCINATIONS

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  • Acknowledgment

    I received a copy of the Vaccine Information Sheet (back of copy) I am receiving and I have had a chance to ask questions.  I understand that serious injury may result from any vaccination and in consideration of receiving the vaccination(s) checked above, voluntarily assume the risk of and accept full liability for any and all injuries and death which may occur as a result of my vaccination(s). I understand that there is no assurance that the vaccine will prevent flu or pneumonia. I understand the benefits and possible side effects of the vaccine(s) and request that the vaccine(s) be given to me.

  • Medicare Part D Review

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  • Medicare Advantage and Prescription Drug Plan Annual Enrollment Period (AEP) is from October 15 to December 7. During this time, you have the opportunity to switch to a new plan, which will take effect on January 1st.

    Plans change their prescription pricing from year to year, and your current plan may not be the most affordable option once the new year begins. Choosing the right plan can result in significant annual savings. Best of all, we can help you find the most affordable plan, for free! While you are under no obligation to change plans, it is recommended that you evaluate all of your options to find the plan that best suits your needs.

    Whether you are new to Medicare, or it's the annual open enrollment period, this review will help you navigate the confusion of Medicare enrollment.

    Even if you're satisfied with your current Medicare coverage, Bayshore Pharmacy will check to see if there is another plan that will offer you better health and/or drug coverage at a more affordable price.

    Before your appointment, we will review your medications, then print a report listing the three best choices for your Medicare Part D plan based on your current medications, based on premiums, deductibles, and copays.

    Your Medicare Part D review will take approximately 15 minutes.

  • SIGNATURE

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  • YOU ARE NOT ELIGIBLE TO RECEIVE THIS COVID-19 VACCINE.

    PLEASE REVIEW YOUR ANSWERS TO THE ELIGIBILITY QUESTIONS.

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