• Registration and Pre-Screening for UITCT COVID Vaccine

  • This form will be used for initial registration and pre-screening for vaccination eligibility at UITCT.  UITCT is following IHS, CDC, and state guidelines for the administration of the vaccine. Registrants will be contacted with the next steps to schedule a vaccine appointment based on selected availability. It is important that you double-check the contact information in this section so that we will be able to reach you. 

    TO BE ELIGIBLE TO RECEIVE THE COVID-19 VACCINE FROM UITCT, YOU MUST BE OVER THE AGE OF 12. The Moderna vaccine is administered in 2 doses, 28 days apart. The Pfizer vaccine is administered in 2 doses, 21 days apart. Vaccine received will be based on availability. A 3rd Dose COVID Booster is currently available to those who are moderate to severely immunocompromised, specifically, solid organ transplant recipients or those who are diagnosed with conditions that are considered to have an equivalent level of immunocompromise. 

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  • The population of moderately and severely immunocompromised people who are currently eligible for COVID boosters included;

    • Active treatment for solid tumor and hematologic malignancies
    • Receipt of solid-organ transplant and taking immunosuppressive therapy
    • Receipt of CAR-T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
    • Moderate or severe primary immunodeficiency (e.g., DiGeorge, Wiskott-Aldrich syndromes)
    • Advanced or untreated HIV infection
    • Active treatment with high-dose corticosteroids (i.e., ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, TNF blockers, and other biologic agents that are immunosuppressive or immunomodulatory.

    If you qualify for the COVID booster and did not receive your previous doses at UITCT, you must bring proof of your first 2 vaccinations with you to your visit. 

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  • You may not be eligible to receive the COVID-19 Vaccine at this time.

    A member of our medical staff will review your case and you will be contacted regarding your eligibility. By submitting this form you agree to allow us to contact you directly by either phone or email regarding the COVID-19 vaccine.

  • YOU ARE ELIGIBLE TO REGISTER TO RECEIVE THE COVID 19 VACCINE FROM UITCT.

    You will be contacted directly to schedule your appointment time.

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