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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)

Pfizer-Biontech and Comirnaty

Moderna and Spikevax

Novavax

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

Pfizer-Biontech

Moderna

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.