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Make Macomb Your Home
LIVING & PLAYING
1 South Main, Mount Clemens, MI, 48043
586-469-7001

Forms

Based on your age, please fill out the appropriate form below and bring it with you on the day of your appointment. Blank forms are available onsite if you are unable to print it at home.

Standard COVID-19 Vaccine Administration Form Age 12 or Older)

Child COVID-19 Vaccination Form (Age 6 months through 11 years old)

 

FDA Approved and Emergency Use Authorizations (EUA) Fact Sheets for Recipients and Caregivers

Pfizer-Biontech and Comirnaty

Recipients and Caregivers: 6 Months Through 4 Years of Age - Monovalent and Bivalent UPDATED 12/8/22

Recipients and Caregivers: 5 through 11 Years of Age - Monovalent and Bivalent UPDATED 12/8/22

Recipients and Caregivers: 12 Years of Age and Older - Monovalent and Bivalent UPDATED 12/8/22

 

Moderna and Spikevax

Recipients and Caregivers: 6 Months Through 5 Years of Age - Monovalent and Bivalent UPDATED 12/7/22

Recipients and Caregivers: 6 Years and Older - Monovalent and Bivalent UPDATED 12/8/22

 

Novavax

EUA Fact Sheets for Recipients and Caregivers UPDATED 10-19-22

 

CDC Approved Emergency Use Instructions (EUI) Fact Sheets for Healthcare Providers and Recipients and Caregivers

Pfizer-Biontech

EUI Fact Sheet for Healthcare Providers -UPDATED 6/24/22

EUI Fact Sheet for Recipients and Caregivers-UPDATED 6/24/22

 

Moderna

EUI Fact Sheet for Healthcare Providers - UPDATED 6/24/22

EUI Fact Sheet for Recipients and Caregivers - UPDATED 6/24/22

 

V-safe Information - V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccination.