Name *

First Name

Last Name

Phone *

(###)

###

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Availability *

I understand that this is a waitlist, and that appointment availabiltiy is subject to capacity. I understand there is no guaranteed timeframe within which I will be able to book an allergy shot appointment with a Magenta Health nurse.

Allergy Serums *

I understand I need to have my allergy serums available and ready to administer prior to booking an appointment with the clinic nurse.

I will bring my allergy serums with me to each appointment, or speak with the clinic nurse about storing my medication at Magenta Health.

Epi-Pen *

We kindly request that you bring your own Epi-Pen to every allergy shot appointment. If you do not bring your Epi-Pen, you will not be able to see the clinic nurse, and you will be required to reschedule your appointment.

I understand I will be required to bring my own Epi-Pen to every allergy shot appointment.