**PLEASE READ ENTIRE FORM**
THE COVID-19 VACCINE IS ONLY OPEN TO THOSE QUALIFYING INDVIDUALS WITHIN PHASE 1A, 1B, and 1C OF COVID-19 VACCINE DISTRIBUTION AS DEFINED BY THE ARKANSAS DEPARTMENT OF HEALTH.
WE WILL UPDATE THIS FORM AS ARKANSAS MOVES INTO DIFFERENT VACCINE PHASES.
**Please understand the C&D Drug store of Russellville, AR has the right to cancel your appointment if you do not meet the criteria deemed necessary by the Arkansas Department Health Guidelines**
For new patients to C&D Drug Store:You MUST provide proof of your credentials or workplace to ensure you qualify for Phase 1A or Phase 1B. Acceptable proof of qualifying credentials or employment may include (but is not limited to):- Name Badge (for workplace)- Professional license- Official letter from employer stating current employment- Check stub
Additionally, you must provide a copy of your driver's license to confirm date of birth. 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.
We will be administering either the Moderna COVID-19 Vaccine or Johnson & Johnson COVID-19 Vaccine on the day you register. You will not be able to change the vaccine type after registering so if you are not willing to get either type of vaccine DO NOT schedule an appointment. You should plan to receive your second dose approximately 28 days (Moderna) after receiving your first dose. Johnson and Johnson only requires ONE dose to be administered.
You will receive a text message reminder before your appointment