Covid-19 Pfizer Vaccine Request for Age 12+

Thank you for allowing us to perform this service for you. In an effort to save you time, please have your insurance card ready.
Also, please bring your insurance card, driver's license (and passport, if applicable) at the time of your appointment. 
By signing below, I attest that all information contained herein are true and accurate.
I release Crosstown Pharmacy from any and all liabilities if I make any false or misleading statements on this form and any unfavorable resulting action(s).
I further attest that I will bring physical proof of my driver's license, passport, and any other official document (s) as proof on the day of my appointment.
**PLEASE REMEMBER TO BRING YOUR OFFICIAL DOCUMENTS WITH YOU AS PROOF**