Maryland Resident COVID Vaccine Appointment Interest
Independent Pharmacies of Maryland (IPMD) is a non-profit organization of local "mom-and-pop" community pharmacies. We are collecting information on Marylanders interested in receiving the COVID vaccine at their local pharmacies. Our goal is to secure vaccine administration ability from the Governor so that the COVID vaccine process can become safer and more accessible for all Maryland residents.
We believe Maryland's local community pharmacies are more caring, efficient, and can more swiftly provide locally-based vaccination sites for our state to speed up administration of the COVID vaccine.
Patients who complete this form will be given scheduling priority when the pharmacy of their choice receives the vaccine and their phase for inoculation is reached.
We request that only 1 form per individual is completed.
Complete this form only if you are a Maryland Resident.
Each resident must complete a separate form. No shared forms will be accepted.
Independent Pharmacies of Maryland is a 501c3 nonprofit organization and will not share, distribute, or sell your information to 3rd parties of any kind. The contact information obtained in this form is for the sole use of the local pharmacy you choose in this survey to apprise you of vaccine availability and appointment times. Demographic information will be aggregated for use in meetings with the Governor and Maryland legislature to impress the importance of including all available pharmacy providers in the state's vaccine distribution plan.