• Pediatric COVID-19 Vaccine Appointment Form

    This form is for scheduling vaccination appointments for those ages 6 months to 11 years. For appointments for those 12 and older, please return to our website healthygallatin.org
  • Please note that all appointments are being held at the Gallatin City-County Health Department located at 215 W Mendenhall St.

  • Personal Information

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  • Health Insurance

  • The vaccine is being provided at no cost.  Your insurace may be charged for the costs of adminstering your vaccination.

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  • Health Questions

  • Consent for Services

  • Please select the link to the corresponding desired vaccine to review the vaccine information prior to consenting & signing below.

    Pfizer (5-11) vaccine info - https://www.fda.gov/media/153717/download

    Moderna (6 months - 5 Years) vaccine info - https://eua.modernatx.com/covid19vaccine-eua/6m-5y-facts-recipient.pdf

    Moderna (6-11) vaccine info - https://eua.modernatx.com/covid19vaccine-eua/bivalent-dose-recipient.pdf

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