A Friendly Reminder: **People age 16 and 17 years old can ONLY receive the Pfizer vaccine.* Please DO NOT sign anyone up who is under 16 years old. It is illegal for anyone under age 16 to get ANY of the COVID-19 vaccines at the moment.
You must bring a valid government issued ID with you to your appointment. For minors under 18 years old, any official document that states the minor’s LEGAL NAME and DATE OF BIRTH is also valid (e.g. Birth certificate, Passport, or Student ID with DOB).
After successfully completing this form, a link to the appointment scheduler will become available to those who are eligible. Please do not try scheduling an appointment without completing the COVID-19 Vaccine Registration Consent Form first.
• Mickey Fine Pharmacy will NOT charge you for the vaccine. We will only bill your insurance for the administration fee. If you do not have insurance, the government will cover the administration fee via your Social Security Number or Government Issued ID Number.
• Mickey Fine Pharmacy will report the administration of the vaccine to the CDC and CAIR (California Immunization Registry) within 48 hours.
Please DO NOT call the pharmacy to try scheduling an appointment. All appointments must be made online.