**PLEASE READ ENTIRE FORM**

WE WILL NOT BE ADMINISTERING VACCINES TO PATIENTS YOUNGER THAN 18 YEARS OF AGE

**Please understand Smith Family Pharmacy has the right to cancel your appointment if you do not meet the criteria deemed necessary by the Arkansas Department Health Guidelines**

For Moderna and Pfizer vaccine boosters:

To be eligible you must meet the following criteria:

1) Age 18 and older

2) Completion of a primary series of vaccine

3) 2 months since last COVID vaccine

For new patients:
Please bring your insurance card, if you have it, and your photo ID. If you do not have insurance, you can still get the vaccine.

Please note that you will be REQUIRED to wait in our observation area for 15 minutes after you receive your vaccine. We ask that you plan accordingly.

For all patients:

If possible, please go to smithfamilypharmacy.com to the "FORMS" tab and complete the COVID-19 Vaccination Consent Form prior to your appointment.