Patient Intake Information

Please feel free to contact us at 608-437-3001 for additional availability

Patient Name *

Patient phone number *

Patient Date of Birth *

Choose Your Vaccine(s) *

Please select which vaccine(s) you would like to receive at this appointment.

Influenza (2024-2025 formulation)

COVID (2024 formulation) available now!

RSV (Abrysvo)

Shingrix – 1st Dose

Shingrix – 2nd Dose (2-3 months after 1st dose)

TDaP (Tetanus, Diptheria, & Pertussis)

Pneumonia

Hepatitis B

Vaccine Appointment

Name: Vaccine Appointment
SKU: 33
Availability: InStock

Free

** ATTENTION! If you would like to book a pediatric vaccine, please read this first! **

For any children LESS THAN 3 YEARS OLD, we need to have a prescription in order to give a vaccine at the Pharmacy. Please contact your pediatrician before coming in for these appointments, we cannot administer to this age group by law without a prescription on hand from a provider. Children 3 to 5 years old DO NOT require a prescription.

Mount Horeb Family Pharmacy offers vaccines for the whole family. Please select your date and time, and then select the vaccine you need. If you need a vaccine that is not on the list, just give us a call.

All vaccines are subject to insurance copays or out-of-pocket expenses.

If you need to cancel this appointment, you may do so by emailing mhfp@mhfamilypharmacy.com

Appointments available for:

Tetanus/TDaP
Shingles
Pneumonia
Influenza
Covid
RSV
Any other vaccines — please check with staff for product availability

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Contact Information

First Name *

Last Name *

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Address *

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Email *

Apartment, Suite, Etc (optional) (optional)

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