FLU / COVID SHOT

(613) 696-6944
Fax: (613) 657-3344
pharmacist@cardinaldrugmart.ca
Mon. - Fri. 9:00 AM - 6:00 PM Sat. 10:00 AM - 3:00 PM

FLU SHOT / COVID VACCINE APPOINTMENT FORM

First Name *

Last Name *

Phone Number *

Email Address *

Country *

Type of the requested shot *

Preferred Date / Time *

Comments

I AGREE TO TRANSFER MY INFORMATION IN THIS EFORM ELECTRONICALLY AND I FULLY UNDERSTAND THE RISK.

reCAPTCHA Invisible *

Name