Jefferson Pharmacy is now offering flu shots for the 2020-2021 flu season. Follow the instructions below to fill out the required form and expedite the time it takes for you to get your flu shot.


  • 1. Download and fill out the Vaccine Waiver Form PDF file in its entirety.
  • 2. If you have Medicare, be sure to also sign within the ‘Medicare benefits’ box towards the bottom of the form.
  • 3. If you currently fill all of your prescriptions at Jefferson Pharmacy, respond “See File” for your current meds.
  • 4. Email with the following:
  • Completed Vaccine Waiver Form
  • Last 4 digits of your Social Security Number
  • Copy of your insurance card (i.e. private insurance, Medicare red, white, & blue card, etc.)
  • Indicate which flu shot you would like (i.e. regular, high-dose, preservative free, pediatric, egg-free). Failure to indicate will result in the pharmacist making their best clinical judgement based on patient’s age
  • Indicate if you would also like the pneumococcal vaccine (Prevnar 13 or Pneumovax 23)

5. Call ahead before arriving to be informed of the wait time and confirm processing.