COVID-19 Vaccination Patient Form
If you have scheduled a vaccination appointment with PHC, you will need to fill out the form below. We will have copies available on site, but our process is made much easier if you are able to have this filled out when you arrive.
Other Important Documents
There are two more important informational documents for vaccine recipients. These do not need to be printed and you do not need them to get vaccinated. You will be offered hard copies of these documents at your vaccination appointment, but we encourage you to download electronic versions and decline a hard copy in order to save paper.
Document #1: V-Safe
Free, Smartphone-Based Tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccination.
Document #2: Vaccine Info Sheet
Fact sheet with important information about COVID-19 vaccines (select the link for the specific vaccine you received or are scheduled to receive)
- Pfizer-BioNTech
- Moderna
- Johnson & Johnson / Janssen
Document #1: V-Safe
Free, Smartphone-Based Tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccination.
Document #2: Vaccine Info Sheet
Fact sheet with important information about COVID-19 vaccines (select the link for the specific vaccine you received or are scheduled to receive)
- Pfizer-BioNTech
- Moderna
- Johnson & Johnson / Janssen
