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Immunization consent form VACCINE CLINIC VERSION 2025 Fall. Version 1

Vaccinations

Please download or print the PDF form provided below. After completing all required fields (unless noted as optional), you may either submit the completed form online using the schedule form below or deliver it to the front desk at RCP for processing.

ROLLINS CARE PHARMACY

ROCKVILLE VACCINE CENTER

​YOUR NEIGHBORHOOD PHARMACY AND VACCINE CENTER

  • Flu

  • COVID-19

  • Shingles

  • Pneumonia (pneumococcal)

  • Hepatitis B

  • HPV (human papillomavirus)

  • Tdap (Tetanus, diphtheria, and whooping cough)

  • RSV (Respiratory Syncytial)

  • Any OTC items you need, including cold, flu, allergy, or sleep aids, can also b e delivered with your prescription.

Schedule Your Vaccination

Pick a Time that works for you; You'll add your details on the next step.

Schedule an appointment
April 2026
SunMonTueWedThuFriSat
Week starting Sunday, April 19
Time zone: Coordinated Universal Time (UTC)Phone call
Wednesday, Apr 22
10:00 AM - 11:00 AM
11:00 AM - 12:00 PM
12:00 PM - 1:00 PM
1:00 PM - 2:00 PM
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