COVID Vaccine Sign-up Steps:

1. Fill out the online sign-up form




2.At end of form, you will be able to schedule your 1st vaccine dose

3. Download a copy of the FDA Moderna Vaccine Emergency Use Authorization (EUA), Facts About COVID Vaccines, & What to expect after getting the COVID vaccine documents

(for your own information)

  (ENGLISH)                (ESPANOL)

4. Once you have submitted the sign-up form and booked your appointment and we have reviewed your form, you will receive a confirmation text message for your 1st dose appointment. (You will automatically have a 2nd dose appointment for exactly 28 days later, on the same day of week and same time as your 1st dose.)

5. Your appointment is NOT CONFIRMED until you receive a confirmation text message (may be up to 1 week later, but at least 2 days prior to your requested date)

6. You will also get a phone call and text message reminder the day prior to your appointment

7. We will automatically make you your 2nd dose appointment for exacly 28 days after your 1st dose, at the same time and same day of the week.


8. The day prior to your 2nd dose you will receive a text and phone call to confirm your 2nd dose appointment. You will NEED to fill out the 2nd dose form prior to your appointment. 

This form is required to receive your 2nd dose 28 days after your 1st dose. Please fill out the day before your 2nd dose appointment

Please do not call our office with individual questions. All of the information about our vaccine clinic is on this webpage.

Vaccine Information
We only carry the Moderna COVID-19 vaccine.  It is a 2 shot series given 28 days apart.
For more information regarding the vaccine, please visit CDC or FDA websites.

What to expect at your appointment:

1. Arrive at our vaccine clinic at 19710 Fisher Ave, Suite F (Formerly Banana Tree Embroidery), Poolesville MD 20837

(Do NOT go to our regular office in Suite J)

2. You will be greeted in our Vaccine Suite information desk and directed to a nurse/doctor for your vaccine

4. You will receive your vaccine and an immunization card or confirmation record.

5. You will wait a minimum of 15 minutes for observation

6. You will check out with our information desk 

We have partnered with WUMCO to assist community members that lack technology access:

For any person who needs assistance filling out our online form due to lack of internet or computer access, please call the WUMCO COVID Vaccine helpline at 240-812-9474 and leave a voicemail and a volunteer will call you back to assist you.


Important Information

COVID vaccine appointments will only be made using this online scheduling method (even for existing patients)

We will NOT accept ANY Walk-ins under any circumstances.

Appointments are 10am-12pm Monday-Friday

Due to the storage and handling requirements, COVID vaccines will NOT be given during regular office visits

We will be following the Maryland State COVID vaccine priority groups guidelines strictly. If you are not in the current priority group, we will deny your request and cancel your appointment. Check their website at for the most up to date information on current priority groups.

COST: There is absolutely no cost to the patient. The federal government is supplying the vaccine for free. We do charge a vaccine administration fee to your insurance but we do not collect any co-pays or deductibles from you. 

If you don't have health insurance, we are offering the vaccine completely free of charge.

We ask only the person with an appointment come to the visit. Only exception is for a person needing assistance.

Scheduling: We will try to accommodate all persons who request an appointment, but due to current demand, there may be limited appointment times and long waits until an appointment is available. We really appreciate your patience. 


We are offering the vaccine as a community service. Our small staff does not have the resources to answer specific questions about the vaccine (other than for our own patients). If you have questions, please contact your own physician or visit the CDC 

We ask that you don't call our main office number as that is reserved for patients needing urgent medical care.

Email is best way to reach us:


Please park your vehicle across the street from our office shopping center at Whalens Commons park, near Poolesville Town Hall. This will allow our elderly and disabled patients to park at our office parking lot.

Poolesville Family Practice

19710 Fisher Ave, Ste J

Poolesville MD 20837

Family Physicians Specializing in You
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© 2020 by Poolesville Family Practice, LLC.