(613) 269-4737
FAX: (613) 269-4738
webinquiries@merrickvilledrugmart.ca
Mon. - Fri. 9:30 AM - 6:00 PM Sat. 10:00 AM - 3 PM

VACCINE FORM

First Name: *

Last Name: *

Phone Number: *

Date of Birth *

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Type of Vaccine *

COVID-19

FLU SHOT

OTHER

Specify What Other Vaccine you need

Preferred time (A staff member will call to confirm the availability): *

Morning Appointment

Afternoon Appointment

Flexible schedule

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