Louisville - Vaccine Schedule

Louisville- Vaccine Schedule
Please choose which vaccine(s) you would like to receive at your appointment.*

Influenza (Flu)Spikevax 24/25 (Covid-19 by Moderna)Prevnar 20 (pneumonia)Shingrix (Shingles)Hepatitis A and B (Age 18+)RSV (Abrysvo)Tetanus/Pertussis (Tdap)
Appointment*
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Social Security Number
Sex
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.

Vaccine Screening Questions
Are you feeling sick today?
Do you take blood thinners (including baby aspirin) or have a bleeding condition?
Have you ever had a serious reaction after receiving a vaccine?
Do you have a history of fainting, particularly with vaccines?
Do you have allergies to gelatin, eggs, or latex?
Have you ever been diagnosed with Guillain-Barré Syndrome (GBS)
In the past 6 months have you been treated with any kind of chemotherapy or radiation therapy?
Have you received any vaccinations or TB skin test in the past 4 weeks?
Do you have a weakened immune system caused by something such as HIV infection or cancer or do you take immunosuppressive drugs or therapies?
Are you currently pregnant?
How many weeks along are you in your pregnancy?
Do you have a cut, injury, puncture or open wound that prompted you to get a tetanus shot?
Have you had COVID-19 vaccine in the past 2 months?

Louisville- Vaccine Schedule