• COVID-19 Vaccination Consent and Release Form

  • DISCLAIMER:

    COMPLETING AN ONLINE CONSENT FORM DOES NOT GUARANTEE COVID-19 VACCINE ADMINISTRATION.

    PRIOR TO COMPLETING AN ONLINE CONSENT FORM, PLEASE ENSURE THAT YOU ARE ELIGIBLE TO RECEIVE THE COVID-19 VACCINE. YOU MAY BE TURNED AWAY AT THE PHARMACY IF ALL ELIGIBILITY CRITERIAS ARE NOT MET PER CDC GUIDANCE.

  • ELIGIBILITY FOR PFIZER-BIONTECH COVID-19 VACCINE

    1ST DOSE

    • 5 YEARS OF AGE AND OLDER 

    2ND DOSE (21 DAYS AFTER 1ST DOSE)

    • 5 YEARS OF AGE AND OLDER

    3RD DOSE (ADDITIONAL / BOOSTER) (6 MONTHS AFTER 2ND DOSE)

    • 16 YEARS OF AGE AND OLDER
       
    • IMMUNOCOMPROMISED (28 DAYS AFTER 2ND DOSE)
      • 12 YEARS OF AGE AND OLDER

    SEE LINKS BELOW FOR CDC GUIDELINE AND RECOMMENDATIONS:

    Pfizer-BioNTech Vaccine Information (5 TO 11 YEARS OF AGE AND OLDER)

    Pfizer-BioNTech Vaccine Information (12 YEARS OF AGE AND OLDER)

    Immunocompromised

    Eligibility for COVID-19 Vaccine Booster Shot

  • ELIGIBILITY FOR MODERNA COVID-19 VACCINE

    1ST DOSE

    • 18 YEARS OF AGE AND OLDER

    2ND DOSE (28 DAYS AFTER 1ST DOSE)

    • 18 YEARS OF AGE AND OLDER

    3RD DOSE (ADDITIONAL / BOOSTER) (6 MONTHS AFTER 2ND DOSE)

    • 18 YEARS OF AGE AND OLDER
    • IMMUNOCOMPROMISED ( 28 DAYS AFTER 2ND DOSE )  
      • 18 YEARS OF AGE AND OLDER
         

    SEE LINKS BELOW FOR CDC GUIDELINE AND RECOMMENDATIONS:

    Moderna Vaccine Information Sheet

    Immunocompromised

    Eligibility for COVID-19 Booster Shots

  • ELIGIBILITY FOR J&J JANSSEN VACCINE

    1ST DOSE

    • 18 YEARS OF AGE AND OLDER  

    2ND DOSE (BOOSTER) (2 MONTHS AFTER 1ST DOSE)

    • 18 YEARS OF AGE AND OLDER

    SEE LINKS BELOW FOR CDC GUIDELINE AND RECOMMENDATIONS:

    Janssen J&J Vaccine Information

    Eligibility for COVID-19 Booster Shots

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