1st Dose Form

Pfizer COVID 19 Vaccine First Dose Scheduling

Cheyenne Laramie County Health Department
This Clinic is open to all individuals in Phase 1 and 2. Must be 12 years or older.

If you have a history of anaphylaxis to another vaccine or injectable medication, we will not be able to administer your vaccine. Please contact you primary care provider.
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Date of Birth (xx/xx/xxxx) *
Your Primary Care Provider or Medical Clinic Name *
Residency *
Occupation & Name of Employer *
Appointment *
Vaccine Clinic Location (Selected Below) *
Should be Empty:

Pfizer COVID 19 Vaccine First Dose Scheduling