Hayden's Pharmacy

Family Owned and Serving the Youngwood and Surrounding Areas Since 1992

COVID-19 VACCINATION REGISTRATION

2023 VACCINATION CLINIC REGISTRATION
0% Complete
1 of 6
BEFORE WE START THE REGISTRATION PROCESS FOR THE VACCINE REGISTRATION:

By continuing, you agree:

1) You are 18 years old or older or

2) the parent or legal guardian of a minor patient 16-18 years old or older or

3) the legal guardian of the patient

• You're not experiencing severe symptoms such as severe shortness of breath, continuous pain or pressure in the chest, or persistent fever greater than 102ºF. If you're experiencing severe symptoms, please seek medical attention immediately.

• You acknowledge that your or the minor patient’s information will be used as described in the Hayden’s Pharmacy Notice of Privacy Practices.

• You acknowledge that any portion of the vaccination administration service cost not paid by your insurance or any other federal or state program will be your responsibility. Payment may be due at the time of the test or patients may be billed after the test is performed.

By selecting "I agree" below, you also have read and accept Hayden’s Pharmacy Clinical Services Terms of Use. *

Standard email is not a secure means of communication and your protected health information that may be contained in our emails to you will not be encrypted. This means that there is risk that your protected health information in the emails could be intercepted and read by, or disclosed to, unauthorized third parties. You accept the risks associated with a non-secure unencrypted email communications from us containing your protected health information,