- Now Administering The COVID-19 Vaccine!
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Meet Your Pharmacist
- Ohio State University
- Serving Circleville and Pickaway County for over 25 years
- Member and past president of OSU Pharmacy Alumni Society
“We specialize in medication therapy management, immunization services, and individualized compounding” - Learn More »
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Health News
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Symptoms Women Shouldn't Ignore
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Steps to Living Longer
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FDA Warns Companies Illegally Selling Dietary Supplements
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FDA Approves New COVID-19 Rx
The US Food and Drug Administration (FDA) has given the thumbs-up to a new treatment for COVID-19. more
Please visit the CDC website cdc.gov/coronavirus/2019-ncov/vaccines/index.html to learn about the benefits and risks (VIS) of the COVID-19 vaccine. Please visit our website (posted at the clinic) to read our Privacy Policy (PP). By signing below, you agree that 1) you reviewed both the VIS and PP, 2) you understand the benefits and risks of the vaccine and you are asking that the vaccine be given to you or the person named on this form for whom you are authorized to make this request, 3) you hereby consent that we can bill your insurance, if applicable, 4) you authorize the release of this vaccination record and all information on this form to your state’s Immunization Program and the CDC, and 5) we can release this record to your doctor, school, or employer if requested. If the person who is being vaccinated is age 17 or under, by signing below, you agree that you are authorized to consent to the vaccination of the patient, and the patient on this form may receive vaccine with or without you, as the parent or guardian, present at the time of vaccination. After receiving your vaccine we recommend you wait at least 15 minutes. If you leave the vaccination site before 15 minutes have passed after your vaccination, you assume any risks associated with not waiting the recommended amount.