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 Record (Age 12 or Older)

Child COVID-19 Vaccination Form (Age 5 to 11 years old)

FDA Approved and Emergency Use Authorizations (EUA)

• Comirnaty (FDA Approved) and Pfizer-Biontech (EUA) Covid-19 Vaccine – Fact Sheet for Recipients and Caregivers for the Comirnaty and Pfizer BioNTech Covid-19 Vaccine.
• Moderna (EUA) Covid-19 Vaccine – FDA-EUA Fact Sheet for Recipients and Caregivers for the Moderna Covid-19 Vaccine.
• Janssen Covid-19 Vaccine – FDA EUA Fact Sheet for Recipients and Caregivers for the Janssen Covid-19 Vaccine.
• Pfizer-Biontech COVID-19 Vaccine for Individuals 5 Through 11 Years of age

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.