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National COVID-19 task force, Register for Covid Vaccine!

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Covid Vaccine Requesteliteweb2021-04-22T16:33:32+00:00

Covid Vaccines | CDC Request

  • Screening

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  • cancer, chronic kidney disease, COPD, heart conditions, coronary artery disease or cardiomyopathy, solid organ transplantation, obesity, pregnant, sickle cell disease, type 2 diabetes mellitus
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  • fever, chills, shortness of breath, fatigue, muscle or body ache, loss of taste or smell
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  • Allergic Reaction

    Have you ever had an allergic reaction to: (This would include a severe allergic reaction [e.g., anaphylaxis] that required treatment with epinephrine or EpiPen® or that caused you to go to the hospital. It would also include an allergic reaction that occurred within 4 hours that caused hives, swelling, or respiratory distress, including wheezing.)
  • A component of a COVID-19 vaccine including either of the following:

    (This would include a severe allergic reaction [e.g., anaphylaxis] that required treatment with epinephrine or EpiPen® or that caused you to go to the hospital. It would also include an allergic reaction that occurred within 4 hours that caused hives, swelling, or respiratory distress, including wheezing.)
  • For Insurance Purposes

  • Address

  • Date Format: MM slash DD slash YYYY
  • Vaccine Scheduling & Location

  • Choose if you are able to arrive at PrimeCare Facility or if you need our team to help service your business or school

  • Date Format: MM slash DD slash YYYY
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  • February 2023

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  • Click For Driving Directions

    611 W MAIN ST
    ARLINGTON, TX   76010-1008

    Questions, call 817-996-1092
  • By signing below, I hereby agree that the information I have given in this form is accurate and complete. I will receive COVID19 vaccine. I release and discharge all the employees, administrators, agents and governmental bodies from any and all claims.

About PrimeCare

PrimeCare Pharmacy is a product of a group of clinical pharmacists with over 16 years of hospital inpatient and ambulatory experience, extensive compounding and pharmacy consulting experience who came together to develop a unique community

Our Location

611 W MAIN ST ARLINGTON, TX   76010-1008
Phone: 817-996-1092
Fax: 817-538-9147

  • Home
  • About PrimeCare
  • Store
  • Contact Us
  • Consultation Request
    • Referral Program
    • Virtual Consultation
  • Refill Prescription
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