Nguyen Pharmacy COVID-19 Vaccine Registration Moderna & Pfizer

Nguyen Pharmacy COVID-19 Vaccine Appointment Scheduler

Please pick a time and fill out the information below.
Select vaccine*

Moderna COVID VaccinePfizer COVID VaccineFlu VaccineShingrixRSV (Respiratory Syncytial Virus)PneumovaxTDAPTyphoidHepatitis BOther
Select Location*

Rainer: 2120- Rainier Ave. South #1 – Seattle, WA 98144
Appointment*
Please fill out the below form.
First Name*
Last Name*
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email (must be unique to each individual)
example@example.com
By completing these fields you are attesting that you are 18+ years of age.*

I am 18+ years old and want the COVID-19 vaccine.
Please review and check the boxes below*

We recommend you to remain on site for 15 minutes for observation. Additional instructions will be provided upon arrival.
Please review the following:

Fact Sheet - https://www.fda.gov/media/144638/download

V-Safe Registration - Get vaccinated. Get your smartphone. Get started with v-safe. (cdc.gov)
Please make sure you review the Fact Sheet and "V-Safe Registration" above.

I attest that I have reviewed Fact Sheet and "V-Safe Registration" above.
Please agree to the following*

Please remember to bring your ID and insurance card to the appointment.
Should be Empty:

Nguyen Pharmacy COVID-19 Vaccine Appointment Scheduler