Request a COVID Vaccine Appointment

Fill out the form below to request an appointment

Stamford Pediatrics is pleased to offer COVID vaccines for patients 6 months of age and older.

Due to the nature of the storage and preparation of the vaccine we cannot accept any walk ins. COVID vaccine will be available during regularly scheduled office appointments. Please fill in the form below to request an appointment.

COVID Vaccine Appointment Request

Fill out the form below and someone from our office will call you to schedule within 2-3 business days. Reminder: This form is not to be used for sick or recheck appointments.

"*" indicates required fields

Child's Information

Child's Name*

First Last

Child's Date of Birth

Parent/Guardian Information

Parent/Guardian Requesting Appt*

First Last

Preferred Phone*

Request a COVID Vaccine Appointment

COVID Vaccine Appointment Request

Child's Information

Parent/Guardian Information

More Appointment Information