COVID-19 Pfizer Booster Vaccine Appointment Registration

COVID-19 Pfizer Booster Vaccine Appointment Registration

Thank you for registering for your Pfizer Booster vaccine. Please completely fill out the form below to register. Booster shots are now available to those 12 years and older who meet the criteria below.
Pre-Screen Questions
Has it been at least 5 months since your 2nd dose of the COVID-19 Pfizer or Moderna vaccine, OR at least 2 months since your COVID-19 Johnson & Johnson vaccine?

Yes No

Please check back when it has been 5 months since your 2nd dose of the Pfizer or Moderna Vaccine, or 2 months since your J&J Vaccine.

Have you been around anyone who has tested positive for COVID-19 lately? *

No Yes

Please make an appointment after your quarantine period is up.

Have you ever had a severe allergic reaction to a vaccine or medication that resulted in hospitalization? *

No Yes

It is recommended you receive your vaccine from your healthcare provider.

Have you received antibody therapy or convalescent plasma for COVID treatment in the past 90 days? *

No Yes

It is recommnded you wait until 90 days past your treatment before you get your vaccine.

Information

In order to schedule your appointment, please enter the information below.
Client Name *

First Name Last Name
Ethnicity *

Hispanic Non-Hispanic
Race *

Black/American American American Indian Asian White Other Race
Do you consider yourself disabled?

No Yes
Any special accommodations needed from our staff for you to get through the clinic?
Wheelchair, interpreter, etc
Date of Birth *

Month Day Year
Date
Gender *
Address *
City *
Zip Code *
Phone Number *
Please enter a valid phone number.
Email
example@example.com

Schedule an Appointment for the Third Dose (Booster) of the Pfizer Vaccine: Friday, January 14, 2022.

Location: Lincoln County Service Center (801 N Sales St., Merrill, WI 54452) - Upper Level
- Please arrive at the vaccine clinic at your scheduled time.
- You will be required to stay 15 minutes after the vaccine is given and 30 minutes if you have a history of anaphylaxis reactions or if you carry an epi pen.
- If you become sick, have to quarantine, or need to cancel, please call us immediately at 715-536-0307.
Things to Remember
- Wear short sleeve shirt and your face covering.
- Get questions answered about the vaccine prior to coming to clinic by calling Lincoln County Health Department COVID-19 triage line at 715-539-1375.
- There is no cost to you for vaccine, but if you are 65 or older please bring your Medicare card (red, white and blue).
- Those 12-17 years old must be accompanied by a parent or gaurdian.
- If you still have your vaccine card, please bring it.
Clinic ends at 3:30pm. You must arrive by 3:35pm. After that time, vaccine will no longer be available.

Please only register once!!
Appointment *
Should be Empty:

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