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
- For individuals age 6 months through 4 years of age: Fact sheet for recipients and caregivers about the Pfizer-Biontech COVID-19 vaccine for use in individuals 6 months through 4 years of age
- For individuals age 5 through 11 years of age: Fact sheet for recipients and caregivers about the Pfizer-Biontech COVID-19 vaccine for use in individuals 5 through 11 years of age
- For individuals age 12 years and older: Fact sheet for recipients and caregivers about Comirnaty (COVID-19 vaccine, mRNA) and the Pfizer-Biontech COVID-19 vaccine for use in individuals 12 years of age and older
Moderna and Spikevax
- For individuals 6 months through 5 years of age: Fact sheet for recipients and caregivers about the Moderna COVID-19 vaccine for use in individuals 6 months through 5 years of age
- For individuals 6 through 11 years of age: Fact sheet for recipients and caregivers about the Moderna COVID-19 vaccine for use in individuals 6 years through 11 years of age
- For individuals 12 years of age and older: Fact sheet for recipients and caregivers about Sikevax (COVID-19 vaccine, mRNA) and the Moderna COVID-19 vaccine in individuals 12 years of age and older
Novavax
- For individuals 12 years of age and older: Fact sheet for recipients and caregivers about the Novavax COVID-19 vaccine (Adjuvanted) for use in individuals 12 years of age and older
CDC Approved Emergency Use Instructions (EUI) Fact Sheets for Recipients and Caregivers
Pfizer-Biontech
- Fact Sheet for Healthcare Providers: Pfizer-BioNTech COVID-19 Vaccine for Primary, Additional, and/or Booster Doses
- Fact Sheet for Recipients and Caregivers: Pfizer-BioNTech COVID-19 Vaccine for Primary, Additional, and/or Booster Doses
Moderna
- Fact Sheet for Healthcare Providers: Moderna COVID-19 Vaccine for Primary, Additional, and/or Booster Doses
- Fact Sheet for Recipients and Caregivers: Moderna COVID-19 Vaccine for Primary, Additional and/or Booster Doses
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.