Vaccine Information

PHS COVID-19 Vaccination Forms

Individuals scheduled to receive a COVID-19 vaccination should fill out the Consent Form for the vaccine to be given and bring the completed form to your scheduled appointment.

VSAFE Information Sheet – English

Hoja de información de VSAFE – Español

Moderna (12 years and older):

Moderna Consent Form – English

Moderna Fact Sheet -English

Formulario de consentimiento de Moderna – Español

Hoja informativa de Moderna – Español

Moderna (6-11 years old):

Moderna 6-11 years – Screening/Consent Form

Moderna 6-11 years – Fact Sheet

Moderna 6-11 años – Hoja de consentimiento

Moderna 6-11 años – Hoja informativa

Moderna (6 months – 5 years old):

Moderna 6 months – 5 years – Screening/Consent Form

Moderna 6 months – 5 years – Fact Sheet

Moderna 6 meses – 5 años – Hoja de consentimiento

Moderna 6 meses – 5 años – Hoja informativa

Questions about the COVID-19 vaccines?
Visit the CDC website HERE to learn more.

Pfizer or COMIRNATY (12 years and older):

Pfizer or COMIRNATY Fact Sheet – English

Pfizer or COMIRNATY Consent Form – English

Hoja informativa de Pfizer o COMIRNATY – Español

Formulario de consentimiento de Pfizer o COMIRNATY – Español

Pfizer (5-11 years old):

Pfizer 5-11 years – Screening/Consent Form

Pfizer 5-11 years – Fact Sheet

Pfizer 5-11 años – Hoja de consentimiento

Pfizer 5-11 años – Hoja informativa

Pfizer (6 months – 4 years old):

Pfizer 6 months – 4 years – Screening/Consent Form

Pfizer 6 months – 4 years – Fact Sheet

Pfizer 6 meses – 4 años – Hoja de consentimiento

Pfizer 6 meses – 4 años – Hoja informativa

Looking to get a Covid-19 Vaccine?

PHS offers the Moderna and Pfizer vaccine.
Individuals ages 5-18 must be accompained by a parent/guardian.

If you are homebound or have a disability

If you are homebound or have a disability that makes it difficult to get a Covid-19 vaccination, please contact our office. A nurse will return your call and make sure you have access to a Covid vaccination. 
Call our office at 402-826-3880.

If you are pregnant and have questions about Covid-19 vaccine

If you would like to speak to someone about Covid-19 vaccination during pregnancy, you can contact MotherToBaby whose experts are available to answer questions in English or Spanish by phone or chat. The free and confidential service is available Monday-Friday, 8am-5pm.
Call 1-866-626-6847

Who Can Get a Booster

Updated CDC Guidance for Fully Vaccinated Individuals